Introduction and Objective: In 4T Study 1, youth with new-onset T1D start CGM <30 days after diagnosis, receive weekly remote CGM data review by a CDCES, and dose changes via secure portal messaging. We describe the policy CDCES used to make dose adjustments and report the safety and effectiveness of CDCESs, making incremental dose changes to facilitate patients reaching and maintaining targets.Methods: Targets were standard CGM metrics and HbA1c <7%. The CDCESs and Pediatric Endocrinologists (Ped. Endo) agreed on criteria for making dose changes (Table). The team prioritized reducing gaps in CGM use and hypoglycemia. CDCESs consulted with Ped. Endo as needed. Messages with suggested dose adjustments and behavior changes were sent via secure portal messaging.Results: A total of 1,564 RPM messages were sent. Most messages were triggered by low time in range (TIR) (63%), hypoglycemia (39%), decline in TIR (13%), or insufficient CGM wear time (7%). There were 2 episodes of severe hypoglycemia. One was due to unexpected activity, and the second was due to intentional excess insulin administration. Mean time <70 was 2%. An HbA1c target of <7% was met by 64%.Conclusion: We created a policy for CDCESs to safely adjust insulin doses and increase patient and clinic interactions between visits. The results demonstrate that the CDCES can work at the top of their certification to adjust insulin doses and maintain target goals without decreasing safety.
J. Leverenz: None. L. Horton: None. B.P. Conrad: None. S. Lin: None. A. Chmielewski: None. F.K. Bishop: None. P. Prahalad: Consultant; Sanofi. D.M. Maahs: Advisory Panel; Abbott, Medtronic. Research Support; Dexcom, Inc. Consultant; Sanofi.
NIDDK – R18DK122422, National Science Foundation (2205084), SDRC (1P30DK 11607401), Stanford HAI, Stanford Maternal & Child Health Research Institute (MCHRI), Stanford REDCap Platform (UL1 T001085)
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