4T Program for New Onset Diabetes

Priya Prahalad, Victoria Y Ding, Dessi P Zaharieva, Ananta Addala, Ramesh Johari, David Scheinker, Manisha Desai, Korey Hood, David M Maahs
The Journal of Clinical Endocrinology & Metabolism, Volume 107, Issue 4, April 2022, Pages 998–1008
https://doi.org/10.1210/clinem/dgab859

Abstract

Context

Youth with type 1 diabetes (T1D) do not meet glycated hemoglobin A_1c (HbA_1c) targets.

Objective

This work aimed to assess HbA_1c outcomes in children with new-onset T1D enrolled in the Teamwork, Targets, Technology and Tight Control (4T) Study.

Methods

HbA_1c levels were compared between the 4T and historical cohorts. HbA_1c differences between cohorts were estimated using locally estimated scatter plot smoothing (LOESS). The change from nadir HbA_1c (month 4) to 12 months post diagnosis was estimated by cohort using a piecewise mixed-effects regression model accounting for age at diagnosis, sex, ethnicity, and insurance type. We recruited 135 youth with newly diagnosed T1D at Stanford Children’s Health. Starting July 2018, all youth within the first month of T1D diagnosis were offered continuous glucose monitoring (CGM) initiation and remote CGM data review was added in March 2019. The main outcomes measure was HbA_1c.

Results

HbA_1c at 6, 9, and 12 months post diagnosis was lower in the 4T cohort than in the historic cohort (−0.54% to −0.52%, and −0.58%, respectively). Within the 4T cohort, HbA_1c at 6, 9, and 12 months post diagnosis was lower in those patients with remote monitoring than those without (−0.14%, −0.18% to −0.14%, respectively). Multivariable regression analysis showed that the 4T cohort experienced a significantly lower increase in HbA_1c between months 4 and 12 (P < .001).

Conclusion

A technology-enabled, team-based approach to intensified new-onset education involving target setting, CGM initiation, and remote data review statistically significantly decreased HbA_1c in youth with T1D 12 months post diagnosis.

You may also like...