Tech-enabled, team-based approach lowers HbA1c levels in youth with T1D

In children with type 1 diabetes (T1D), glycated haemoglobin A1c (HbA1c) significantly decreases at 12 months after diagnosis with the help of a technology-enabled, team-based approach to intensified new-onset education involving target setting, continuous glucose monitoring (CGM), and remote data review, results of a study have shown.

The authors assessed outcomes in children with new-onset T1D enrolled in the Teamwork, Targets, Technology and Tight Control (4T) Study by comparing HbA1c levels between the 4T and historical cohorts. They estimated between-group differences in HbA1c using locally estimated scatter plot smoothing (LOESS).

Using a piecewise mixed-effects regression model accounting for age at diagnosis, sex, ethnicity, and insurance type, the authors calculated the change from nadir HbA1c (month 4) to 12 months postdiagnosis by cohort.

Overall, 135 youth with new-onset T1D at Stanford Children’s Health were included in the study. Starting July 2018, all participants within the first month of T1D diagnosis were offered CGM initiation; remote CGM data review was added in March 2019.

Children in the 4T cohort had lower HbA1c at 6, 9, and 12 months following diagnosis than those in the historic cohort (‒0.54 percent to ‒0.52 percent and ‒0.58 percent, respectively). Within the 4T cohort, patients with remote monitoring had lower HbA1c at 6, 9, and 12 months postdiagnosis than those without (‒0.14 percent, ‒0.18 percent to ‒0.14 percent, respectively).

On multivariable regression analysis, a significantly lower increase in HbA1c was observed in the 4T cohort between months 4 and 12 (p<0.001).