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Objective:Develop workflows and billing processes for a Certified Diabetes Care and Education Specialist (CDCES)-led remote patient monitoring (RPM) program to transition the Teamwork, Targets, Technology, and Tight Control (4T) Study to our clinic’s standard of care. Methods:We identified stakeholders within a pediatric endocrinology clinic (hospital compliance, billing specialists, and clinical informatics) to identify, discuss, and approve billing codes and workflow. The group evaluated billing code stipulations, such as the timing of continuous glucose monitor (CGM) interpretation, scope of work, providers’ licensing, and electronic health record (EHR) documentation to meet billing compliance standards. We developed a CDCES workflow for asynchronous CGM interpretation and intervention and initiated an RPM billing pilot. Results:We built a workflow for CGM interpretation (billing code: 95251) with the CDCES as the service provider. The workflow includes data review, patient communications, and documentation. Over the first month of the pilot, RPM billing codes were submitted for 52 patients. The average reimbursement rate was $110.33 for commercial insurance (60% of patients) and $46.95 for public insurance (40% of patients) per code occurrence. Conclusions:Continuous involvement of CDCES and hospital stakeholders was essential to operationalize all relevant aspects of clinical care, workflows, compliance, documentation, and billing. CGM interpretation with RPM billing allows CDCES to work at the top of their licensing credential, increase clinical care touch points, and provide a business case for expansion. As evidence of the clinical benefits of RPM increases, the processes developed here may facilitate broader adoption of revenue-generating CDCES-led care to fund RPM. 

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. 

Abstract AimsPsychosocial impacts of early continuous glucose monitoring (CGM) initiation in youth soon after type 1 diabetes diagnosis are underexplored. We report parent/guardian and youth patient‐reported outcomes (PROs) that measure psychosocial states for families in 4T Study 1. Materials and MethodsOf the 133 families in the 4T Study 1, 132 parent/guardian and 66 youth (≥11 years) were eligible to complete PROs. PROs evaluated included diabetes distress, global health, diabetes technology attitudes and CGM benefits/burden scales. Temporal trends of PROs were assessed via generalised linear mixed effects regression. Sociodemographic and clinical characteristics associated with PROs were evaluated. Psychosocial associations were evaluated by regressing parental distress on youth distress. ResultsPRO completion rates were 85.6% and varied between parent/guardian and youth. Throughout the study, parent/guardian and youth distress remained low and youth had increased technology acceptance (p = 0.046). Each additional month of CGM use was associated with a 14% decrease in the odds of experiencing diabetes distress (aOR = 0.86, 95% CI [0.76, 0.99],p = 0.029). Additionally, higher time‐in‐range was associated with decreased diabetes distress (p = 0.048). Age, diabetic ketoacidosis at diagnosis, gender, ethnicity, insurance status and language spoken were not associated with PROs. ConclusionsInitiation of CGM shortly after type 1 diabetes diagnosis does not have unintended negative psychological consequences. Longer duration of CGM use was associated with decreased youth distress and technology acceptance increased throughout the study. 

Continuous glucose monitoring (CGM) use soon after T1D diagnosis in the 4T Study was associated with improved glycemic outcomes. We evaluated participant factors associated with elevated versus in target A1c for youth in the 4T Study. All youth from the 4T Study 1 (n=133) were evaluated. In this analysis, the 110 youth who had a final A1c between 6-13 months were included in a complete case analysis. These 110 youth were comparable to the 133 4T Study 1 youth by race/ethnicity, insurance, preferred language, and age. Group differences by non-ordered A1c categories were evaluated for categorical (race/ethnicity, insurance, gender, and language) and continuous (age and time from CGM start) variables via chi-square and ANOVA, respectively. A majority of youth in the 4T Study 1 met glycemic targets (65% with A1c ≤7% between 6-13 months post-diagnosis). Age, race/ethnicity, and insurance status were significantly associated with A1c categories (p=0.02 for all; Table). Higher A1c categories were more likely to include Hispanic youth and youth with public insurance. In the 4T Study 1, Hispanic youth and youth with public insurance had higher A1c categories despite similar CGM access and training. These findings suggest the need to address additional drivers of disparities in addition to CGM access. Approaches focused on health equity are required to improve glycemic outcomes in all youth newly diagnosed with T1D. Disclosure J. Kim: None. D. P. Zaharieva: Advisory Panel; Dexcom, Inc., Research Support; Hemsley Charitable Trust, International Society for Pediatric and Adolescent Diabetes, Insulet Corporation, Speaker's Bureau; American Diabetes Association, Ascensia Diabetes Care, Medtronic. F. K. Bishop: None. D. Scheinker: None. R. Johari: None. M. Desai: None. K. K. Hood: Consultant; Cecelia Health. D. M. Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. A. Addala: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK13134201, R18DK122422)