Early Access to Diabetes Tech for Type 1 Children
By Arvind Sommi
A new study from Stanford has found that early access to diabetes technology might lead to better health outcomes.
Navigating your child’s type 1 diagnosis can be stressful, and teaching them how to use a continuous glucose monitor (CGM) soon after their diagnosis (when you have to learn how to use the technology yourself) might seem daunting. Do the health benefits of accessing diabetes care technology early on outweigh the initial learning curve? A new study from Stanford University, named the Teamwork, Targets, Technology and Tight Control (4T) Study, offers insights that might help answer this question.
How the study was organized
In the 4T program, 135 children with newly diagnosed type 1 diabetes were provided a CGM (Dexcom G6) soon after their diagnosis. 124 patients started using the CGM within one month of diagnosis, while the remaining 11 started after one month. This group was named the 4T cohort.
The researchers compared the A1C results from the 4T cohort with a previous group of 272 newly diagnosed children who were provided standard treatment (e.g., they were not offered a CGM within the first month), the Historical cohort. Only 1.8% or 5 children of the Historical cohort started using a CGM within the first month, and about half eventually started using CGM after one month.
Additionally, during the study, participants in the 4T program were offered the opportunity to automatically upload their CGM data to their electronic medical records (EMR) so that it could be remotely monitored by their healthcare team. Researchers then also compared the health outcomes of those in the 4T cohort who opted in to this feature and those who did not.
Key findings from the 4T study
The children in the 4T cohort had a higher average A1C level at diagnosis when compared to the Historical cohort, but after one year, they ended with a lower average A1C.
Average A1C Over Time Among Participants In Each Cohort
|
Months After Diagnosis |
4T Cohort |
Historical Cohort |
|
Diabetes Onset |
11.5% |
10.2% |
|
6 Months |
6.8% |
7.3% |
|
9 Months |
7.2% |
7.7% |
|
12 Months |
7.4% |
7.9% |
Key Finding 1: The 4T cohort had a lower average A1C than the Historical cohort after one year, which suggests that early CGM access might have had a positive impact for the newly diagnosed children.
Rather than being overwhelmed by having to learn how to use a CGM so soon after diagnosis, many families were able to quickly adapt and benefitted from not having to do fingersticks throughout the day. In fact, parents actually reported a decrease in stress and an improvement in their sleep.
We spoke with Dr. Ananta Addala, one of the study’s authors and a pediatric endocrinologist at Stanford University, to learn more about how the 4T cohort overcame the steep learning curve.
“Part of the success is that we had scheduled visits to both start and follow up on CGM to provide CGM-specific education so that youth and families can best use the CGM without feeling overwhelmed, overloaded, or unsure of what to do with the CGM data,” she said, “while there was initially some worry from providers that this would be too much for the family, we quickly saw that this was not the case.”
Within the 4T cohort, researchers also compared the A1C data of participants who chose to opt in for remote monitoring with those who did not
Average A1C Over Time Among Participants Based on Remote Monitoring Status
|
Months After Diagnosis |
Remote Monitoring |
No Remote Monitoring |
|
Diabetes Onset |
11.0% |
11.8% |
|
6 Months |
6.7% |
6.8% |
|
9 Months |
7.1% |
7.2% |
|
12 Months |
7.3% |
7.4% |
Key Finding 2: Those who opted in for remote monitoring had a lower average A1C, suggesting that by providing the healthcare team with access to their remote data, it allowed them to receive more frequent dosing recommendations from their healthcare provider resulting in better outcomes.
Dr. Addala elaborated on the advantages of remote monitoring, “We found that we were able to address hypoglycemia that can present as youth enter the honeymoon phase and hyperglycemia as they leave the honeymoon.”
Significance of this study
This study provides further support that early access to CGM technology for newly diagnosed children could lead to improved health outcomes. However, there are barriers to accessing this technology for many families. To learn more, read “Racial Disparities in Diabetes Technology and Care.”
The researchers hope to further their understanding of how early access to technology and education can help children better manage their diabetes in the long run by examining the use of automated insulin delivery systems, exercise education, and physical activity tracking.
