Alonso, G.T, Thapa, S, Maahs, D, Wolf, R, Bishop, F, DeSalvo, D, Addala, A, Prahalad, P, Mann, E, Jacobsen, L, Clements, M, Rompicherla, S, Rioles, N.

Introduction and Objective: Less than 20% of US youth with type 1 diabetes (T1D) achieve the ADA glycemic target of A1c <7%. Recent A1c improvements are strongly associated with increased use of diabetes technology.

Methods: We analyzed data for patients aged 0.5-21 years diagnosed with T1D in 2018-2023 from 13 pediatric clinics in the T1D Exchange QI Collaborative (T1DX-QI). One clinic began 4T in 2018 with early, equitable technology initiation, a curriculum to communicate clear targets, and remote patient monitoring (RPM) to achieve tight range (Pilot, 7/2018-6/2020; Study 1, 6/2020-3/2022). We compared mean A1c 1 year after diagnosis between 4T and T1DX-QI clinics.

Results: A total of 562 patients were included in the 4T clinic, and 13,145 patients in T1DX-QI clinics. At 12 months post-diagnosis, CGM use was 97% vs 76%; mean A1c was 7.4% vs 7.9%, with 50.0% vs 32.9% reaching A1c <7% in 4T and T1DX-QI clinics, respectively (all p<0.001). No T1DX-QI clinic had lower A1c or a higher percent reaching A1c <7% than the 4T clinic. Patients in the 4T clinic were 2.5 times more likely to achieve A1c <7% than those in T1DX-QI clinics [OR 2.5, CI 1.8,3.4]. A1c measures from 4T Pilot and Study 1 periods are shown.

Conclusion: Although glycemia improved across all clinics, improvement was greater in 4T. Early diabetes technology adoption and a structured RPM education program were key differentiators. Translating 4T’s benefits to other T1DX-QI clinics is a future goal.

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