Priya Prahalad1,2, Victoria Y Ding3, Dessi P Zaharieva1, Ananta Addala1, Ramesh Johari2,4, David Scheinker1,2,4,5, Manisha Desai3, Korey Hood1,2, David M Maahs1,2,6. 1. Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, California 94304, USA. 2. Stanford Diabetes Research Center, Stanford University, Stanford, California 94304, USA. 3. Department of Medicine, Division of Biomedical Informatics Research, Stanford University, Stanford, California 94304, USA. 4. Department of Management Science and Engineering, Stanford University, Stanford, California 94304, USA. 5. Clinical Excellence Research Center, Stanford University, Stanford, California 94304, USA. 6. Department of Health Research and Policy (Epidemiology) Stanford University, Stanford, California 94304, USA.
Abstract
CONTEXT: Youth with type 1 diabetes (T1D) do not meet glycated hemoglobin A1c (HbA1c) targets. OBJECTIVE: This work aimed to assess HbA1c outcomes in children with new-onset T1D enrolled in the Teamwork, Targets, Technology and Tight Control (4T) Study. METHODS: HbA1c levels were compared between the 4T and historical cohorts. HbA1c differences between cohorts were estimated using locally estimated scatter plot smoothing (LOESS). The change from nadir HbA1c (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 HbA1c. RESULTS: HbA1c 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, HbA1c 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 HbA1c 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 HbA1c in youth with T1D 12 months post diagnosis.
CONTEXT: Youth with type 1 diabetes (T1D) do not meet glycated hemoglobin A1c (HbA1c) targets. OBJECTIVE: This work aimed to assess HbA1c outcomes in children with new-onset T1D enrolled in the Teamwork, Targets, Technology and Tight Control (4T) Study. METHODS: HbA1c levels were compared between the 4T and historical cohorts. HbA1c differences between cohorts were estimated using locally estimated scatter plot smoothing (LOESS). The change from nadir HbA1c (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 HbA1c. RESULTS: HbA1c 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, HbA1c 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 HbA1c 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 HbA1c in youth with T1D 12 months post diagnosis.
Authors: Rajiv B Kumar; Nira D Goren; David E Stark; Dennis P Wall; Christopher A Longhurst Journal: J Am Med Inform Assoc Date: 2016-03-27 Impact factor: 4.497
Authors: Richard M Bergenstal; Roy W Beck; Kelly L Close; George Grunberger; David B Sacks; Aaron Kowalski; Adam S Brown; Lutz Heinemann; Grazia Aleppo; Donna B Ryan; Tonya D Riddlesworth; William T Cefalu Journal: Diabetes Care Date: 2018-09-17 Impact factor: 19.112
Authors: Molly L Tanenbaum; Dessi P Zaharieva; Ananta Addala; Priya Prahalad; Julie A Hooper; Brianna Leverenz; Ana L Cortes; Nora Arrizon-Ruiz; Erica Pang; Franziska Bishop; David M Maahs Journal: Diabet Med Date: 2022-08-08 Impact factor: 4.213