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Improvement of Care & Outcome

FRAMEWORK CONDITIONS FOR SUCCESFUL USE OF TECHNOLOGY IN T1D

Mul D, Aanstoot HJ, Dekker P, de Vries M, Sas T, Veeze HJ.

Improvement of A1C can be obtained in an optimal and enabling setting that combines technology and patient-HCP contacts through data-upload and eHealth. 45th Annual of the International Society for Pediatric and Adolescent Diabetes (ISPAD), Oct 30-Nov 2 2019, Abstract: #O23

Although diabetes technology (e.g. insulin-pumps including CGM and FGM) can improve glycemic control in controlled trials, better outcomes through increased use were not seen in real-world data from T1D Exchange (DTT 2019). Diabeter delivers standardized, value-based, comprehensive T1D care. To try to explain outcome differences between Diabeter and T1D Exchange, technology use and eHealth activities were evaluated.

 

Cross-sectional data from 2018 on treatment modality (MDI/pump), uploads, glucose monitoring methods (SMBG/FGM/CGM) and A1C (last value of year) were extracted from Vcare, Diabeter’s custom-build electronic disease management system. To establish the overall improvement in care/outcome between 2017 and 2018 an in-house developed measure, the individual net improvement score (NIS), was used.

 

Key Findings:

  • About two thirds of patients used pumps and one third used CGM
  • Despite higher pump and CGM use among T1D Exchange patients, Diabeter patients showed overall lower A1C by age and treatment modality
  • The percentage of patients who uploaded glucose data was considerable higher for Diabeter patients: 88% vs <40% for T1D Exchange
  • Use of NIS (range from -2 to +2) also shows improvement of HbA1c over time (56% improved [positive NIS], 28% were stable [NIS=0])
  • These data indicate improved glucose control in patients receiving care according to Diabeters value-based healthcare model, combining use of technology with frequent uploads and contacts between patient and team. This model facilitates improved pediatric glucose control compared with standard care

For abstract click here (page 16).

For presentation click here.

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