Intensive and frequent contact with diabetes care providers has been shown to improve glycemic control and reduce risk of complications among T1D pediatric patients. However, remote monitoring utilizing newer Bluetooth enabled technology has not been fully evaluated. In a randomized clinical trial, 117 children and adolescents with T1D were assigned to either intensive remote therapy (IRT) or conventional care (CC) for 6 months. Both groups continued routine clinic appointments quarterly and uploaded blood glucose (BG) and device data weekly. Data for patients assigned to IRT were reviewed weekly, and patients were contacted if a regimen adjustment was indicated. The primary outcome of the trial was change in HbA1c from baseline, but the focus of this summary is weekly BG measurements reported from BG meters.In total, 107 subjects (53 in the IRT group) uploaded weekly data. In the first 26 weeks, patients uploaded data an average of 24.7 weeks. The outcomes of interest were summaries of BG measurements, namely average and standard deviation of BG levels and whether measurements were in, below, or above the target range (70-140 mg/dL). Multiple observations per subject were analyzed using generalized linear mixed effects models. Patients in the IRT group had average BG levels 19.3 mg/dL lower than the CC group (P=0.0007). The difference between standard deviations of BG levels was not statistically significant. IRT increased the odds of BG measurements in the target range (OR: 1.25, P=0.0037), as well as the odds of being below the target range (OR: 1.47, P=0.0031), presumably because BG levels were lower. The IRT and CC groups had 24.6% and 20.6% of measurements in the range respectively and 4.7% and 3.2% below the range respectively. These results suggest that IRT can lower BG levels in children and adolescents. Given these promising findings, further research is warranted, as this technology has potential to add convenience and efficiency to T1D management and increase time in target.
L.M. Gandrud: Consultant; Self; UnitedHealth Group. T.L. Barnes: None. D.A. Watson: None.