646-P: Improved Outcomes with Intensive Follow-up in Pediatric Diabetes Patients with Care Concerns

Introduction: Standards of pediatric diabetes care recommend routine clinic visits quarterly, but in some cases more frequent visits may aid in improving hyperglycemia. This study aimed to determine if intensive follow-up affected DM outcomes.

Methods: EHR data was reviewed (2020-23) to identify subjects with a prior diagnosis of T1D or T2D on insulin therapy at start of intervention. Increased follow-up was initiated for hyperglycemia (84%), education needs (64%), DM burnout (42%), behavioral health (BH) concern (42%), family dynamics (34%), recent onset (32%), pump start (32%), or young age (10%). BH interventions targeted coping, problem-solving, and communication. Data analyzed with SPSS. Primary outcomes were A1c, time-in-range (TIR); secondary outcomes included medications, technology use, and ED/hospital visits.

Results: Cohort (n=50) included subjects with T1D (66%) and T2D (32%). Intervention occurred 2.4 years post-diagnosis with a mean duration of 6 months or 5 clinic visits. Initial A1c (n=50) was 10.85% (95% CI 10.23-11.48, SD 2.18); post-A1c (n=50) was 8.35% (95% CI 7.87-8.92, SD 1.93); mean decrease in A1c was 2.5% (95% CI 1.89-3.10, SD 2.13, p<0.001). Initial TIR (n=17) was 31.47% (95% CI 17.21-45.72, SD 27.72); post-TIR was 47.35% (95% CI 37.39-57.31, SD 19.37); mean increase was15.88% (95% CI 8.71-21.8, SD 3.467, p=0.007). Subjects with identified DM burnout, BH concerns, DSM-5 TR diagnosis, or IEP were just as successful in achieving A1c improvement. There was a reduction in MDI therapy (p<0.001) and an increase in hybrid closed-loop pump use (p<0.001). There was an increase in CGM use (p<0.001) and a reduction in ED visits/hospitalizations (p<0.001).

Conclusion: In a pediatric diabetes cohort with identified care concerns, significant improvement in mean A1c/TIR and increased diabetes technology utilization were seen following brief intensive intervention. These findings strongly support short-term increased follow-up to improve diabetes outcomes.