Abstract
Many youth with type 1 diabetes (T1D) do not achieve hemoglobin A1c (HbA1c) targets. The mean HbA1c of youth in the USA is higher than much of the developed world. Mean HbA1c in other nations has been successfully modified following benchmarking and quality improvement methods. In this review, we describe the novel 4T approach—teamwork, targets, technology, and tight control—to diabetes management in youth with new-onset T1D. In this program, the diabetes care team (physicians, nurse practitioners, certified diabetes educators, dieticians, social workers, psychologists, and exercise physiologists) work closely to deliver diabetes education from diagnosis. Part of the education curriculum involves early integration of technology, specifically continuous glucose monitoring (CGM), and developing a curriculum around using the CGM to maintain tight control and optimize quality of life.
Highlights
The Diabetes Control and Complications Trial (DCCT) firmly established the efficacy of intensive diabetes management to reduce vascular complications of type 1 diabetes (T1D) [1, 2]
The international SWEET registry reports the mean hemoglobin A1c (HbA1c) in individual clinics in many developing countries such as India, Nepal, and Mexico are in the 8–9.5% range, suggesting that even in resource-poor situations, better glucose control than the USA can be achieved [13]
continuous glucose monitoring (CGM) systems have been approved for use in insulin dosing and for factory calibration, allowing it to be a true substitute for self-monitoring of blood glucose (SMBG)
Summary
Many youth with type 1 diabetes (T1D) do not achieve hemoglobin A1c (HbA1c) targets. The mean HbA1c of youth in the USA is higher than much of the developed world. We describe the novel 4T approach— teamwork, targets, technology, and tight control—to diabetes management in youth with new-onset T1D. In this program, the diabetes care team (physicians, nurse practitioners, certified diabetes educators, dieticians, social workers, psychologists, and exercise physiologists) work closely to deliver diabetes education from diagnosis. Part of the education curriculum involves early integration of technology, continuous glucose monitoring (CGM), and developing a curriculum around using the CGM to maintain tight control and optimize quality of life
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