Early initiation of CGM may improve glycemic control in youth with type 1 diabetes
medwireNews: Use of continuous glucose monitoring (CGM) within the first month of diagnosis is associated with an improvement in glycemic control among youth with type 1 diabetes, indicate findings from the 4T study.
Speaking at the virtual ADA 81st Scientific Sessions, Priya Prahalad (Stanford University, Palo Alto, California, USA) explained that children and adolescents with type 1 diabetes typically start using diabetes technology “months to years” after diagnosis, and the researchers hypothesized that earlier use would be associated with better outcomes.
In the 4T study (Teamwork, Targets, Technology, and Tight Control), 136 participants aged a median of 9.6 years who were diagnosed with type 1 diabetes in 2018–2020 initiated CGM in the first month after diagnosis, with a median time to initiation of 7 days. The researchers compared glycated hemoglobin (HbA1c) trajectories in these people with the trajectories in a historic cohort of 272 individuals aged a median of 9.7 years who were diagnosed in 2014–2016 and initiated CGM after a median of 221 days.
Prahalad reported that average HbA1c levels were highest at the time of diagnosis and lowest at around 3 months in both the 4T cohort and the historic control cohort, with a gradual increase thereafter. HbA1c decreased to a similar degree between baseline and the 3-month follow-up in both groups, from 11.48% to 6.92% (102–52 mmol/mol) and 10.24% to 6.75% (88–50 mmol/mol), respectively.
However, by the 6-month follow-up, average HbA1c levels were approximately 0.5 percentage points lower in the 4T group compared with the historic cohort, at 6.77% versus 7.29% (50 vs 56 mmol/mol), and this difference persisted at the 12-month follow-up, at 7.42% versus 7.94% (58 vs 63 mmol/mol).
In accordance with these findings, the proportion of individuals with HbA1c levels below 7.5% (58 mmol/mol) was higher among participants of the 4T study than those in the historic cohort at the 6-month (70 vs 66%), 9-month (65 vs 53%), 12-month (57 vs 45%), and 15-month (60 vs 38%) follow-up visits.
Prahalad noted that the 4T study participants who were diagnosed between March 2019 and May 2020 were offered weekly remote monitoring with a CGM care team, and an additional study presented as a poster compared glycemic outcomes in those patients who took up the offer with those given CGM alone.
In this study, Prahalad and colleagues found that the 89 participants undergoing CGM with remote monitoring had lower average HbA1c levels than the 47 given CGM alone at the 6-month follow-up, at 6.69% versus 6.88% (50 vs 52 mmol/mol), and this difference was maintained at 12 months, at 7.32% versus 7.56% (57 vs 59 mmol/mol).
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