Roadmap to Achieving Continuous Glucose Monitoring Equity: Insights From the T1D Exchange Quality Improvement Collaborative

Early Continuous Glucose Monitor Use in Children and Adolescents With Type 1 Diabetes: Rates of Initiation and Impact on Glycemic Outcomes

OBJECTIVE

Early initiation of continuous glucose monitor (CGM) after type 1 diabetes (T1D) diagnosis has been associated with lower hemoglobin A1C (HbA1c) in single-institution studies. This multicenter study evaluated the association between the timing of CGM initiation and HbA1c at 3 years postdiagnosis.

RESEARCH DESIGN AND METHODS

Data were obtained from the T1D Exchange Quality Improvement Collaborative (T1DX-QI) electronic health record database from 25 pediatric centers and included children and adolescents ≤18 years old diagnosed with T1D in 2019 and 2020. CGM initiation and glycemic outcomes were followed for 3 years after diagnosis. Locally estimated scatterplot smoothing plots evaluated the relationship between timing of CGM initiation and HbA1c over time, and logistic regression models were used to adjust for potential confounders.

RESULTS

There were 4,164 people included in this analysis, mean age was 12.6 (SD 3.5) years, and 37% had public health insurance. Of the 93% (n = 3,877) who initiated CGM within 3 years of T1D diagnosis, 21% did so at 0-3 months, 14% at 3-6 months, 14% at 6-12 months, and 51% after 12 months. Median HbA1c at 3 years postdiagnosis was lower for the 0-3 and 3-6 months groups compared with the 6-12 months and non-CGM user groups (7.9%, 7.9%, 8.4%, and 9.5%, respectively). Adjusted odds of HbA1c >9% were lowest for the 0-3 months group followed by the 3-6 months group.

CONCLUSIONS

In summary, early initiation of CGM within the first 6 months of diagnosis is associated with improved HbA1c outcomes at 3 years postdiagnosis.

Continuous glucose sensor accuracy: beyond the headline metric

The promotion of continuous glucose monitoring (CGM) to standard of care for type 1 diabetes and insulin-treated type 2 diabetes reflects a robust and wide evidence base for the technology's effectiveness supported by real-world efficacy data. Multiple CGM devices are available worldwide and are marketed, in part, based on accuracy data. In this Viewpoint, we argue that accuracy metrics are no longer a point of difference between CGM devices as almost all exceed an acceptable threshold. We also argue that domains of standardisation, clinical outcomes, and sustainability should now be given primacy as CGM devices seek to be implemented for new indications. These domains are key for the success of the next generation of CGM devices. Additionally, we discuss the need to address inequalities in accessing clinically impactful technologies.

Improving Outcomes for People with Type 1 Diabetes Through Collaboration: Summary of Type 1 Diabetes Exchange Quality Improvement Collaborative Studies

Type 1 diabetes (T1D) management has evolved over the last decade. Innovations and groundbreaking research have paved the way for improved outcomes for people with T1D. One of the major T1D focused research network that has supported real-world research studies in the United States is the T1D Exchange Quality Improvement Collaborative (T1DX-QI) Network.T1DX-QI is a large multicenter network of 55 T1D clinics that uses quality improvement, health equity framework, and population health principles to improve outcomes for people with T1D. This article summarizes insights from T1DX-QI clinical and population health improvement studies.

Roadmap to the Effective Use of Continuous Glucose Monitoring: Innovation, Investigation, and Implementation

For 25 years, continuous glucose monitoring (CGM) has been evolving into what it is now: a key tool to both measure individuals' glycemic status and to help guide their day-to-day management of diabetes. Through a series of engineering innovations, clinical investigations, and efforts to optimize workflow implementation, the use of CGM is helping to transform diabetes care. This article presents a roadmap to the effective use of CGM that outlines past, present, and possible future advances in harnessing the potential of CGM to improve the lives of many people with diabetes, with an emphasis on ensuring that CGM technology is available to all who could benefit from its use.

Roadmap to Continuous Glucose Monitoring Adoption and Improved Outcomes in Endocrinology: The 4T (Teamwork, Targets, Technology, and Tight Control) Program

Glucose monitoring is essential for the management of type 1 diabetes and has evolved from urine glucose monitoring in the early 1900s to home blood glucose monitoring in the 1980s to continuous glucose monitoring (CGM) today. Youth with type 1 diabetes struggle to meet A1C goals; however, CGM is associated with improved A1C in these youth and is recommended as a standard of care by diabetes professional organizations. Despite their utility, expanding uptake of CGM systems has been challenging, especially in minoritized communities. The 4T (Teamwork, Targets, Technology, and Tight Control) program was developed using a team-based approach to set consistent glycemic targets and equitably initiate CGM and remote patient monitoring in all youth with new-onset type 1 diabetes. In the pilot 4T study, youth in the 4T cohort had a 0.5% improvement in A1C 12 months after diabetes diagnosis compared with those in the historical cohort. The 4T program can serve as a roadmap for other multidisciplinary pediatric type 1 diabetes clinics to increase CGM adoption and improve glycemic outcomes.