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 type 1 diabetes 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 people with type 1 diabetes used pumps and one third used CGM
• Despite higher pump and CGM use among T1D Exchange participants, people with type 1 diabete at Diabeter showed overall lower A1C by age and treatment modality
• The percentage of people with type 1 diabetes who uploaded glucose data was considerable higher at Diabeter: 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 people with type 1 diabetes receiving care according to Diabeters value-based healthcare model, combining use of technology with frequent uploads and contacts between people with type 1 diabetes and the care team. This model facilitates improved pediatric glucose control compared with standard care

For abstract click here (page 16).

For presentation click here.