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Background/Objective: The Diabetes Control and Complications Trial showed that intensive glucose management, including frequent dose adjustments, improves outcomes. This has not been fully translated to clinical care.
Methods: We established the 4T Program (Teamwork, Targets, Technology, and Tight Control) to intensify education in the first year of diabetes to improve glucose time-in-range (TIR) and quality of life. Youth are started on continuous glucose monitoring (CGM) in the first month after diagnosis. Participants receive weekly dose adjustments by certified diabetes care and education specialists(CDCES). To facilitate remote CGM data review, a population health dashboard, Timely Interventions for Diabetes Excellence(TIDE), was developed iteratively as a collaboration between clinicians, engineers, and CDCES (Figure). TIDE employs flags for patients not meeting target guidelines based on CGM metrics-. Metrics were tested and refined to identify individuals who would most benefit from dose adjustments (TIR <65%, % time< 70 mg/dL >4%, % time <54 mg/dL >1%, % time worn <50%, and change in TIR >10%).
Results: Youth in the 4T Program had a 0.5% reduction in HbA1c compared to historic controls. TIDE decreased the time CDCES spent reviewing data by 60%. Deployment was initially on laptops, but in collaboration with the hospital information services(IS) team, it is now deployed on a hospital server. The program has scaled to include >250 patients.
Conclusions: Population health management tools can bring the learnings of the DCCT to more people with diabetes. Next steps to scale the 4T approach to other institutions will require co-operation between clinicians and hospital IS.
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