Improving Clinical Outcomes in Newly Diagnosed Pediatric Type 1 Diabetes: Teamwork, Targets, Technology, and Tight Control—The 4T Study

Prahalad, Priya; Zaharieva, Dessi P.; Addala, Ananta; New, Christin; Scheinker, David; Desai, Manisha; Hood, Korey K.; Maahs, David M.

doi:10.3389/fendo.2020.00360

Cited by 48 publications

(49 citation statements)

References 72 publications

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“…One caveat is that the benefits of CGM correlate with the frequency of and access to ongoing device use 3,4 . Early introduction to CGM in conjunction with health care provider/care team education and insulin‐dosing adjustments can allow for tighter glucose level ranges during the clinical remission phase 5 . It has also been shown that CGM initiation in the new onset period is in fact feasible and well accepted by youth and their families 6 .…”

Section: Introductionmentioning

confidence: 99%

‘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

et al. 2021

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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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Section: Introductionmentioning

confidence: 99%

‘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

et al. 2021

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“…Since this analysis is part of an ongoing pilot study, additional participants were added weekly. 18…”

Section: Methodsmentioning

confidence: 99%

Population-level management of Type 1 diabetes via continuous glucose monitoring and algorithm-enabled patient prioritization: Precision health meets population health

Ferstad

Vallon

Jun

et al. 2021

Preprint

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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 minutes 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 = 0.6-16.9pp) greater time-in-range (70-180 mg/dL) glucoses compared to 25 control patients who did not qualify at twelve 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.

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“…Enhanced time and attention both during and outside of clinic are important in improving HbA1c outcomes, even in highly motivated patients. 7,10,74 Therefore, in addition to increased access to sophisticated insulin delivery and glucose sensor systems, patients and their families should also receive enhanced support necessary to overcome special barriers to management and assist with long-term acceptance and utilization. 75,76 Frequent contact with the family in their home could be accomplished with video conferencing apps.…”

Section: Can Technology Be Used To Overcome Racial Disparity In Hba1c Outcomes?mentioning

confidence: 99%

Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes?

Chalew

Delamater

Washington

et al. 2021

J Diabetes Sci Technol

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Achieving normal or near-normal glycemic control as reflected by HbA1c levels in patients with type 1 diabetes (T1D) is important for preventing the development and progression of chronic complications. Despite delineation and dissemination of HbA1c management targets and advances in insulin pharmacology, insulin delivery systems, and glucose monitoring, the majority of children with T1D do not achieve HbA1c goals. In particular, African Americans are more likely not to reach HbA1c goals and have persistently higher HbA1c than Non-Hispanic Whites. Availability of pumps and other technology has not eliminated the disparity in HbA1c. Multiple factors play a role in the persisting racial disparity in HbA1c outcome. The carefully designed application and deployment of new technology to help the patient/family and facilitate the supportive role of the diabetes management team may be able to overcome racial disparity in glycemic outcome and improve patient quality of life.

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Improving Clinical Outcomes in Newly Diagnosed Pediatric Type 1 Diabetes: Teamwork, Targets, Technology, and Tight Control—The 4T Study

Cited by 48 publications

References 72 publications

‘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

‘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

Population-level management of Type 1 diabetes via continuous glucose monitoring and algorithm-enabled patient prioritization: Precision health meets population health

Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes?

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