Undergoing an intensive diabetes education program, in combination with an early start to continuous glucose monitoring (CGM), is linked to improved blood glucose control in children with newly diagnosed type 1 diabetes, according to a new study published in the Journal of Clinical Endocrinology & Metabolism.
A lot of research in recent years has focused on ways to improve early treatment for type 1 diabetes — including ways to slow the progression of the disease. One study, published last year, showed that early and more intensive treatment for type 1 diabetes reduces the risk for long-term cardiovascular and kidney complications. Another study looked at how genetic testing could help prevent early hospitalization for type 1 diabetes, by helping doctors monitor the development of the disease before it leads to a crisis like diabetic ketoacidosis. And earlier this year, a study found that taking a vitamin D supplement may help slow the progression of early type 1 diabetes — leading to greater maintenance of the body’s own insulin production, and a slow rise in blood glucose levels, over time.
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For the latest study, researchers at Stanford University implemented what they called the 4T program — a combination of teamwork, targets, technology, and tight control — in a racially diverse group of 135 children with newly diagnosed type 1 diabetes, with an average age of 9.7 years. As part of the program, participants whose families decided to start CGM soon after their diagnosis had a follow-up visit with a diabetes educator to learn how to use this technology, and how CGM fits in with overall diabetes management. All data from CGM — blood glucose readings and trends — was automatically shared with the study’s health care providers and reviewed weekly. The providers could then use this data to recommend adjustments to insulin doses, if needed. The researchers were interested in comparing A1C levels (a measure of long-term blood glucose control) between participants in the 4T program and a similar group of children who underwent standard therapy after their diabetes diagnosis. In both groups, A1C levels were measured between 4 and 12 months after the initial diabetes diagnosis, as noted in a Healio article on the study.
Tech-focused, team-based approach found to benefit A1C levels
The researchers found that the 4T group had a higher starting A1C level than the standard therapy group — 12.2% compared with 10.7%. Otherwise the two groups were similar in most measurable ways at the beginning of the study, including having the same average age. But A1C trends weren’t the same in the two groups. In the standard therapy group, A1C rose steadily, while it rose more slowly in the 4T group. After six months, the 4T group had an average A1C level 0.54% lower than the standard therapy group, and this lower A1C level was maintained after nine months (0.52% lower) and after 12 months (0.58% lower). Overall, average A1C between four and 12 months increased by 1.47% in the standard treatment group and by 1.32% in the 4T group. After 12 months, 66% of the 4T group was meeting the target A1C level of 7.5% or lower, compared with 43% of the standard treatment group meeting this target.
The researchers concluded that “a technology-enabled, team-based approach to intensified new-onset education involving target setting, CGM initiation, and remote data review” was effective at improving blood glucose control in children with type 1 diabetes. They noted, though that their approach required a team of engineers and data scientists to help health care professionals understand CGM data and make any recommendations for adjustments to insulin dosing. Most health care settings that treat children with type 1 diabetes don’t have these kinds of resources, which is why the Stanford team is working on developing a data analysis system that can be shared with other health care providers. Still, any effective implementation of a similar program would require enough diabetes educators and other specialists to regularly engage with participants’ CGM readings and communicate with families about their diabetes management.
Want to learn more about managing after-meal blood sugar levels? Read “Strike the Spike II,” “Dealing With After-Meal Blood Sugar Spikes? Don’t Skip Breakfast,” “Managing Your Blood Glucose Ups and Downs” and “How to Lower Blood Sugar? Take a 10-Minute Walk After Meals, Study Says.”
