Advancements and future directions in the teamwork, targets, technology, and tight control—the 4T study: improving clinical outcomes in newly diagnosed pediatric type 1 diabetes

Abstract

Purpose of reviewThe benefits of intensive diabetes management have been established by the Diabetes Control and Complications Trial. However, challenges with optimizing glycemic management in youth with type 1 diabetes (T1D) remain across pediatric clinics in the United States. This article will review our Teamwork, Targets, Technology, and Tight Control (4T) study that implements emerging diabetes technology into clinical practice with a team approach to sustain tight glycemic control from the onset of T1D and beyond to optimize clinical outcomes. Recent findingsDuring the 4T Pilot study and study 1, our team-based approach to intensive target setting, education, and remote data review has led to significant improvements in hemoglobin A1c throughout the first year of T1D diagnosis in youth, as well as family and provider satisfaction.

Disparities in Hemoglobin A1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

“…The Pilot-4T study protocol has been described previously . Briefly, all youths with newly diagnosed T1D were approached to enroll in the Pilot-4T study to initiate CGM with the Dexcom G6 system (Dexcom) within 1 month of diagnosis.…”

“…The Pilot-4T study protocol has been described previously. 20 , 21 , 22 , 23 Briefly, all youths with newly diagnosed T1D were approached to enroll in the Pilot-4T study to initiate CGM with the Dexcom G6 system (Dexcom) within 1 month of diagnosis. The Pilot-4T cohort comprised youths newly diagnosed with T1D between July 25, 2018, and June 15, 2020.…”

A model to design financially sustainable algorithm-enabled remote patient monitoring for pediatric type 1 diabetes care

“…TIDE is currently in use for youth in four institutional review board-approved studies: 4T pilot, 4T phase 1, 4T phase 2 (15), and CGM Time in Range Program at Stanford (CGM TIPS). Among the four, TIDE is now used to support scaling RPM to 299 youth with T1D (Table 1).…”

Adding glycemic and physical activity metrics to a multimodal algorithm-enabled decision-support tool for type 1 diabetes care: Keys to implementation and opportunities

“…The current TIDE care model facilitates population-level algorithm-enabled remote patient monitoring (RPM) based on continuous glucose monitoring (CGM) data ( 15 ). TIDE is being used as a part of the larger R18-funded pragmatic research study called the Teamwork, Targets, Technology, and Tight Control 4T Study ( 17 – 21 ). Based on feedback from CDCES’, other team members, and analysis of historical patient data, TIDE is constantly being updated with improvements to the visual interface, the algorithmic ranking, and to better fit the clinic workflows ( 14 ).…”

“…In the current 4T Exercise Study, a subset of participants from the main 4T Study (11+ years of age) are also started on a physical activity tracker (Garmin vívosmart ® 4 or Garmin Venu ® Sq) around one month following T1D diagnosis and CGM start. Participants in the study are trained to use the watch and instructed to wear it throughout the 12 month study duration, with the goal of capturing at least two weeks of activity data each month ( 17 ). The activity trackers capture data including, but not limited to, heart rate, activity type, active kilocalories, step count, stress, metabolic equivalents (METS), etc.…”