P2.N275: Healthcare Utilization, HbA1c and Team vs Non-team Differences in Outcomes with Use of Continuous Glucose Monitoring (CGM) in Pediatric Patients with Type 1 Diabetes

Purpose/Objectives: Real time continuous glucose monitoring (CGM) has significantly improved the quality of life, blood glucose Time in Range (TIR), as well as HbA1c outcomes for insulin dependent individuals with type 1 diabetes (T1D). The aim of this study was to evaluate the frequency of diabetes-related acute healthcare visits before and after transitioning to CGM in the pediatric T1D population at two select medical centers: one offering a team-based care model (including a physician, social worker, registered dietitian, and certified diabetes educators) and one without such a team. Additionally, the study also analyzed changes in HbA1c levels, an important measure of long-term blood glucose control.

Design/Methods: A retrospective cohort analysis of the digital medical records of pediatric patients 18 years of age and younger, diagnosed with type 1 diabetes from two centers of Kaiser Permanente Southern California was conducted. Analyses included 184 patients utilizing CGM who previously used self-monitored blood glucose (SMBG) alone for at least 24 months before starting CGM. Insulin delivery was either by multiple daily injections (MDI) or stand-alone continuous subcutaneous insulin infusion (CSII). All data collection occurred pre-CGM integration (hybrid-closed loop) to CSII pumps.

Results: Overall, for both centers, the mean HbA1c improved from an average pre-CGM at 9.42% to 8.96% post-CGM (p < 0.001). The number of acute care visits utilizing the emergency room, primary care physician, urgent care, or hospital decreased significantly from a mean of 0.57 pre-CGM to 0.34 post-CGM (p < 0.001). Both centers saw improvements in the outcome measures; however, the center with a team-based care model demonstrated more significant decreases in acute care visits and HbA1c levels (> 0.5%). Furthermore, this study found that females at both centers achieved larger reductions in HbA1c compared to males. Males from the center with a non team-based model did not experience a significant reduction in HbA1c (p=0.14).

Conclusion/Discussion: This study affirms the benefits of CGM in the pediatric population. The utilization of acute care services for hypoglycemia or hyperglycemia was significantly decreased. Additionally, the team-based care model demonstrated less acute care utilization pre-CGM and HbA1c outcomes compared to the non team-based clinic with males showing greater benefits in a team-based clinic. Therefore, future studies could investigate whether factors such as the care model influence pediatric T1D outcomes, especially with respect to gender.