ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This prospective, pragmatic, open-label study assessed the impact of a systematic and equitable digital-health-team-based care program designed to achieve tight glycemic targets (HbA1c <7%) through early technology use and remote patient monitoring, in young people with newly diagnosed T1D. The program was successful: 68% of participants achieved target HbA1c, and an average 65% time in glucose range at one-year post-diagnosis.

Despite advances in diabetes management, still few young people with T1D meet recommended glucose targets (1). This is worrying given the known association between suboptimal glycemic target and risk of complications. Diabetes technologies, such as continuous glucose monitoring (CGM) and hybrid closed loop, enable better glycemic outcomes and quality of life (2). However, there are wide inequalities in access to these technologies, with low use among minority racial and ethnic groups, low socioeconomic status, and at low levels of public health insurance (3).

The US-based Teamwork, Targets, Technology and Tight Control study 1 (4T Study 1) used a population-based approach to promote wider and early access to technology and achieve glycemic targets (HbA1c<7%) in young people with new onset T1D. A key aim of the program was to ensure early CGM initiation (within the first month of diagnosis) and remote patient monitoring. The intervention successfully achieved better HbA1c compared to a historical cohort study and a previous pilot study (4T study, 6.6%; pilot study, 7.2%; historical cohort, 7.7%). Nearly 70% of participants met the glycemic target HbA1c <7% at one-year after diagnosis.

This study highlights the positive impact of early implementation of technology and remote patient monitoring to create more equity in care delivery and allow timely resolution of difficulties due to technology use or suboptimal diabetes targets. It shows that financial support is needed to equip individuals with the required diabetes management tools. To allow equitable access, CGM were provided to all young people regardless of health insurance coverage. iPod Touch devices were offered to those without a compatible smartphone. The study also highlighted the key role of a multidisciplinary diverse team, able to engage with individuals from different ethnic and socio-economic backgrounds.

Overall, the study showed that population-based tools to prioritize care are essential to reduce inequities in diabetes care. Although tested in a selected setting, the 4T Study 1 model could be implemented and adapted in other clinical settings.

References: 1. Gerhardsson P, Schwandt A, Witsch M, Kordonouri O, Svensson J, Forsander G, et al. The SWEET Project 10-Year Benchmarking in 19 Countries Worldwide Is Associated with Improved HbA1c and Increased Use of Diabetes Technology in Youth with Type 1 Diabetes. Diabetes Technol Ther. 2021;23(7):491-9.2. Boughton CK, Hovorka R. The role of automated insulin delivery technology in diabetes. Diabetologia. 2024;67(10):2034-44.3. Burckhardt MA, Addala A, de Bock M. Editorial: Equity in type 1 diabetes technology and beyond: where are we in 2022? Front Endocrinol (Lausanne). 2024;15:1400240.