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Abstract ContextYouth with type 1 diabetes (T1D) struggle to meet and sustain hemoglobin A1c (HbA1c) targets. Youth enrolled in the Pilot 4T Study improved HbA1c by 0.5% at 1 year, compared to historical controls. ObjectiveTo assess 3 years of glycemic outcomes in the Pilot 4T Study. MethodsThe Pilot 4T Extension cohort was prospectively followed to determine changes in HbA1c and continuous glucose monitoring (CGM) metrics over 3 years at the Stanford Medicine Children's Health Diabetes Clinic. Youth with T1D in the Pilot 4T Study enrolled in the extension phase started CGM in the first month of diabetes diagnosis, received intensified education and remote patient monitoring (RPM) weekly for the first year of diabetes diagnosis, and monthly RPM in the extension phase. HbA1c and CGM metrics were evaluated over the first 3 years of diagnosis. ResultsIn the Pilot 4T cohort, 78.5% (n = 102) of participants enrolled in the study extension phase and were followed through 3 years. The adjusted difference in HbA1c at 3 years was 1.2% (95% CI 0.7%-1.7%) lower in the Pilot 4T cohort than in the Historical cohort. In the Pilot 4T cohort, 68% and 37% met the <7.5% and <7% HbA1c targets at 3 years, respectively, compared to 37% and 20% in the Historical cohort. ConclusionYouth with T1D in the Pilot 4T extension phase sustained improvements in HbA1c over 3 years. Focusing resources on intensive management during the first year after T1D diagnosis may impact long-term glycemia. 

Abstract Urgent pediatric hospital readmissions are common, costly, and often preventable. Existing prediction models, based solely on discharge data, fail to accurately identify pediatric patients at-risk or urgent readmission. Remote patient monitoring (RPM) leverages wearable technology to provide real-time health data, enabling care teams to detect and respond to early signs of clinical deterioration. Emerging evidence suggests RPM may be a promising strategy to improve pediatric postdischarge outcomes and reduce urgent hospital readmissions. 

Introduction:The Virtual Diabetes Specialty Clinic (VDiSC) study demonstrated the feasibility of providing comprehensive diabetes care entirely virtually by combining virtual visits with continuous glucose monitoring support and remote patient monitoring (RPM). However, the financial sustainability of this model remains uncertain. Methods:We developed a financial model to estimate the variable costs and revenues of virtual diabetes care, using visit data from the 234 VDiSC participants with type 1 or type 2 diabetes. Data included virtual visits with certified diabetes care and education specialists (CDCES), endocrinologists, and behavioral health services (BHS). The model estimated care utilization, variable costs, reimbursement revenue, gross profit, and gross profit margin per member, per month (PMPM) for privately insured, publicly insured, and overall clinic populations (75% privately insured). We performed two-way sensitivity analyses on key parameters. Results:Gross profit and gross profit margin PMPM (95% confidence interval) were estimated at $−4 ($−14.00 to $5.68) and −4% (−3% to −6%) for publicly insured patients; $267.26 ($256.59-$277.93) and 73% (58%-88%) for privately insured patients; and $199.41 ($58.43-$340.39) and 67% (32%-102%) for the overall clinic. Profits were primarily driven by CDCES visits and RPM. Results were sensitive to insurance mix, cost-to-charge ratio, and commercial-to-Medicare price ratio. Conclusions:Virtual diabetes care can be financially viable, although profitability relies on privately insured patients. The analysis excluded fixed costs of clinic infrastructure, and securing reimbursement may be challenging in practice. The financial model is adaptable to various care settings and can serve as a planning tool for virtual diabetes clinics. 

Background:Youth with type 1 diabetes (T1D) and public insurance have lower diabetes technology use. This pilot study assessed the feasibility of a program to support continuous glucose monitor (CGM) use with remote patient monitoring (RPM) to improve glycemia for youth with established T1D and public insurance. Methods:From August 2020 to June 2023, we provided CGM with RPM support via patient portal messaging for youth with established T1D on public insurance with challenges obtaining consistent CGM supplies. We prospectively collected hemoglobin A_1c(HbA_1c), standard CGM metrics, and diabetes technology use over 12 months. Results:The cohort included 91 youths with median age at enrollment 14.7 years, duration of diabetes 4.4 years, 33% non-English speakers, and 44% Hispanic. Continuous glucose monitor data were consistently available (≥70%) in 23% of the participants. For the 64% of participants with paired HbA_1cvalues at enrollment and study end, the median HbA_1cdecreased from 9.8% to 9.0% ( P < .001). Insulin pump users increased from 31 to 48 and automated insulin delivery users increased from 11 to 38. Conclusions:We established a program to support CGM use in youth with T1D and barriers to consistent CGM supplies, offering lessons for other clinics to address disparities with team-based, algorithm-enabled, remote T1D care. This real-world pilot and feasibility study noted challenges with low levels of protocol adherence and obtaining complete data in this cohort. Future iterations of the program should explore RPM communication methods that better align with this population’s preferences to increase participant engagement.