1165-P: 4T Study—Changing Clinical Processes Increases Technology Use at T1D Diagnosis

Abstract

Use of diabetes technology (CGM, pump) is recommended for people with T1D, and early CGM initiation leads to improved glucose values. We compare %CGM and %pump use and time to initiation from T1D diagnosis in the Historical cohort, 4T Pilot, and 4T Study 1 and the associated workflow changes to increase early technology use. CGM initiation within 30 days of diagnosis increased from 2% in the historical cohort to 92% in Pilot 4T to 98% in 4T Study 1 (Table). Days to pump initiation from TID diagnosis decreased from 272 in the historical cohort to 144 days in Study 1. From 2014-2016 pumps and CGM were initiated when families expressed interest or if the provider discussed them. Families were required to attend a pre-pump class where the CDCES introduced pumps and CGMs prior to starting technology. During the 4T Pilot and 4T Study 1, CGMs were introduced and started during the first month of diagnosis. In Study 1, families were encouraged to attend pump class and initiate AID. The CDCES team does the CGM teach, CGM follow-up, pre-pump classes, and insulin pump starts for the families in preferred language. In 4T Study 2 (enrolling) standard of care is to complete a pre-pump class in the first 3 months after diagnosis. Changes in processes can lead to early implementation of diabetes technology. A structured, team-based process to introduce, reduce barriers, and encourage families to utilize diabetes technology increases early initiation. Disclosure B.P.Conrad: Advisory Panel; Edgepark medical supplies, Consultant; Abbott Diabetes. P.Prahalad: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. F.K.Bishop: None. J.Leverenz: None. A.Chmielewski: None. P.Sagan: None. J.Senaldi: None. A.Martinez-singh: None. S.Lin: None. I.Chan: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R18DK122422); The Leona M. and Harry B. Helmsley Charitable Trust (G-2002-04251-2); International Society for Pediatric and Adolescent Diabetes/JDRF (1P30DK, 11607401); Lucile Packard Child