Objective: Continuous glucose monitor (CGM) use is associated with improved glucose control. We describe the effect of continued and interrupted CGM use on hemoglobin A1c (HbA1c) in youth with public insurance. Methods: We reviewed 956 visits from 264 youth with type 1 diabetes (T1D) and public insurance. Demographic data, HbA1c and two-week CGM data were collected. Youth were classified as never user, consistent user, insurance discontinuer, and selfdiscontinuer. Visits were categorized as never-user visit, visit before CGM start, visit after CGM start, visit with continued CGM use, visit with initial loss of CGM, visit with continued loss of CGM, and visit where CGM is regained after loss. Multivariate regression adjusting for age, sex, race, diabetes duration, initial HbA1c, and body mass index were used to calculate adjusted mean and delta HbA1c. Results: Adjusted mean HbA1c was lowest for the consistent user group (HbA1c 8.6%;[95%CI 7.9,9.3]). Delta HbA1c (calculated from visit before CGM start) was lower for visit after CGM start (−0.39%;[95%CI −0.78,−0.02]) and visit with continued CGM use (−0.29%;[95%CI −0.61,0.02]), whereas it was higher for visit with initial loss of CGM (0.40%;[95%CI −0.06,0.86]), visit with continued loss of CGM (0.46%;[95%CI 0.06,0.85]), and visit where CGM is regained after loss (0.57%;[95%CI 0.06,1.10]). Conclusions: Youth with public insurance using CGM have improved HbA1c, but only when CGM use is uninterrupted. Interruptions in use, primarily due to gaps in insurance coverage of CGM, were associated with increased HbA1c. These data support both initial and ongoing coverage of CGM for youth with T1D and public insurance. K E Y W O R D S diabetes technology, health policy, insurance, minority health, pediatric type 1 diabetes 1 | INTRODUCTION Optimal glucose control paired with improved quality of life is an important management goal for youth with type 1 diabetes (T1D) and providers who care for them. 1-3 Incorporation of continuous glucose This work was previously presented in a poster abstract form at the International Society for Pediatric and Adolescent Society's 45th Annual Conference.

Aim: This study aimed to capture the experience of parents of youth with recent onset Type 1 diabetes who initiated use of continuous glucose monitoring (CGM) technology soon after diagnosis, which is a new practice. Methods: Focus groups and individual interviews were conducted with parents of youth with Type 1 diabetes who had early initiation of CGM as part of a new clinical protocol. Interviewers used a semi-structured interview guide to elicit feedback and experiences with starting CGM within 30 days of diagnosis, and the benefits and barriers they experienced when adjusting to this technology. Groups and interviews were audio recorded, transcribed and analysed using content analysis. Results: Participants were 16 parents (age 44.13 ± 8.43 years; 75% female; 56.25% non-Hispanic White) of youth (age 12.38 ± 4.15 years; 50% female; 50% non-Hispanic White; diabetes duration 10.35 ± 3.89 months) who initiated CGM 11.31 ± 7.33 days after diabetes diagnosis. Overall, parents reported high levels of satisfaction with starting CGM within a month of diagnosis and described a high level of reliance on the technology to help manage their child's diabetes. All participants recommended early CGM initiation for future families and were committed to continue using the technology for the foreseeable future, provided that insurance covered it. Conclusion: Parents experienced CGM initiation shortly after their child's Type 1 diabetes diagnosis as a highly beneficial and essential part of adjusting to living with diabetes. K E Y W O R D S children and adolescents, devices, health care delivery, psychological aspects What's new?• Continuous glucose monitoring (CGM) in a paediatric Type 1 diabetes population has benefits for time spent in glucose target range and parents' sleep and stress levels; introducing CGM shortly after Type 1 diabetes diagnosis is a new clinical practice.'The idea of the CGM is definitely a forever' (FG5, mother, son aged 14) '[My child will] have to use it the whole time she's in college, and I think she will continue to use it after because it's just so much more helpful for her too. We all agree it's been life-changing for us. As long as we can keep the insurance and everything covered, she'll keep using it, I'm assuming, forever' (FG3, father, daughter aged 19)Abbreviation: CGM, continuous glucose monitoring.How to cite this article: Tanenbaum ML, Zaharieva DP, Addala A, et al. 'I was ready for it at the beginning': Parent experiences with early introduction of continuous glucose monitoring following their child's Type 1 diabetes diagnosis. Diabet Med.

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Objective To develop and scale algorithm‐enabled patient prioritization to improve population‐level management of type 1 diabetes (T1D) in a pediatric clinic with fixed resources, using telemedicine and remote monitoring of patients via continuous glucose monitor (CGM) data review. Research design and methods We adapted consensus glucose targets for T1D patients using CGM to identify interpretable clinical criteria to prioritize patients for weekly provider review. The criteria were constructed to manage the number of patients reviewed weekly and identify patients who most needed provider contact. We developed an interactive dashboard to display CGM data relevant for the patients prioritized for review. Results The introduction of the new criteria and interactive dashboard was associated with a 60% reduction in the mean time spent by diabetes team members who remotely and asynchronously reviewed patient data and contacted patients, from 3.2 ± 0.20 to 1.3 ± 0.24 min per patient per week. Given fixed resources for review, this corresponded to an estimated 147% increase in weekly clinic capacity. Patients who qualified for and received remote review (n = 58) have associated 8.8 percentage points (pp) (95% CI = 0.6–16.9 pp) greater time‐in‐range (70–180 mg/dl) glucoses compared to 25 control patients who did not qualify at 12 months after T1D onset. Conclusions An algorithm‐enabled prioritization of T1D patients with CGM for asynchronous remote review reduced provider time spent per patient and was associated with improved time‐in‐range.

Aim Initiating continuous glucose monitoring (CGM) shortly after Type 1 diabetes diagnosis has glycaemic and quality of life benefits for youth with Type 1 diabetes and their families. The SARS‐CoV‐2 pandemic led to a rapid shift to virtual delivery of CGM initiation visits. We aimed to understand parents' experiences receiving virtual care to initiate CGM within 30 days of diagnosis. Methods We held focus groups and interviews using a semi‐structured interview guide with parents of youth who initiated CGM over telehealth within 30 days of diagnosis during the SARS‐CoV‐2 pandemic. Questions aimed to explore experiences of starting CGM virtually. Groups and interviews were audio‐recorded, transcribed and analysed using thematic analysis. Results Participants were 16 English‐speaking parents (age 43 ± 6 years; 63% female) of 15 youth (age 9 ± 4 years; 47% female; 47% non‐Hispanic White, 20% Hispanic, 13% Asian, 7% Black, 13% other). They described multiple benefits of the virtual visit including convenient access to high‐quality care; integrating Type 1 diabetes care into daily life; and being in the comfort of home. A minority experienced challenges with virtual care delivery; most preferred the virtual format. Participants expressed that clinics should offer a choice of virtual or in‐person to families initiating CGM in the future. Conclusion Most parents appreciated receiving CGM initiation education via telehealth and felt it should be an option offered to all families. Further efforts can continue to enhance CGM initiation teaching virtually to address identified barriers.