Abstract
In pediatric type 1 diabetes (T1D) care, collaboration among youth, caregivers, and medical providers is important for optimal glycemic control; however, many youth are still unable to achieve A1c goals (A1c < 7.5%). This study examined the effect of a 10-week clinical care pilot program on A1c in youth with suboptimal diabetes control. The program consisted of two primary components: 1) weekly individualized health coaching and insulin dose adjustments and 2) incentives for program completion and decreases in A1c. The program was offered to 179 youth with T1D receiving routine diabetes care (A1c 8.6%-10%). Twenty-five caregivers/youth (youth ages 4-18; Mage=11.6 years, Mean A1c=9.4%) completed the 10-week coaching sessions and follow-up A1c measure. Coaching, conducted at no cost via phone call and email (with caregiver and/or youth), was individualized based on family needs and conducted by diabetes team members. Each youth/family who participated and returned for an A1c measure received a gift card to a local grocery store to further dietary goals. Youth were entered into a drawing to win an iPad upon completion of A1c measure and for reductions in A1c. Of the 25 participants, 20 (80%) exhibited a decrease in A1c level at the end of the 10 weeks (mean decreased A1c of 0.5% across 25). Seventeen youth (68%) had a decrease in A1c greater than 0.5% and 7 youth (28%) had a decrease greater than 1.0%. Results from qualitative interview with health coaches suggest increased engagement and empathy from diabetes team members. Communication via phone/email coupled with outcome based incentives was an effective strategy for decreasing A1c in the short-term. This data suggests that moving from an office centric model of care to a sustained health coaching model delivered via phone/email may be a more effective strategy to improve diabetes outcomes. Patient satisfaction and sustained effect of the intervention will be monitored over time. Disclosure L. Clary: None. A. Dauber: Consultant; Self; Novo Nordisk Inc. Research Support; Self; Novo Nordisk Inc. S. Arboine: None. M.S. Dillon: None. B. Eshete: None. S. Hatchell: None. S. Jones: None. P. Vaidyanathan: None. F.R. Cogen: None.
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