909-P: Real-World Assessment of Connected Remote Continuous Glucose Monitoring Combined with Tele-consultations in a Pediatric Type 1 Diabetes Population

Objectives: To study effectiveness and predictors of tele-monitoring on metabolic outcome of T1DM CGM treated children in real world.

Methods: CGM data of 47 T1DM patients (3-18 years) were studied during two years (October 2016 - September 2018): 6 months without bi-weekly tele-consultations (T0), 6 months with connected CGM and tele-consultations (T1-2), 6 months washout period and 6 months without tele-consultations (T3). HbA1C, time-in-hypo, and days-in-hospital were measured. Relationship between metabolic outcome and age, gender, baseline HbA1C, insulin regimen (pen vs. pump), puberty and compliance towards the tele-consultations, was studied.

Results: 2.836.322 CGM values (16.479 total days) were analysed. Baseline HbA1C (±SD) for the total group was 7.7±1% and did not change significantly; time-in-hypo decreased from 8±5% (T0) to 5±3% (T2) (p=0.002) and increased to 6±4% (T3) (p=0.143). HbA1C of patients with HbA1C > 7.5% at T0 decreased significantly from 8.3±0.6% to 8±0.7% at T1 (p=0.024), to 8.1±1% at T2 (p=0.176) and stabilized at 8.1±1 at T3 (p=0.742). During 6 months of tele-monitoring, 352 therapy adjustments were proposed during 585 tele-consultations. In compliant patients (n=8) with baseline HbA1C >7.5%, HbA1C changed from 8.1±0.5% (T0) to 7.6±0.4% (T1) (p=0.029), to 7.3±0.3% (T2) (p=0.001), and to 7.9±0.9% at T3 (p=0.035) while time in hypo was on average 6% and 7% before and after the tele-consultations and 4% during tele-consultations. Time-in-range with this group improved by 6% during 6 months of tele-consultations, and number of serious hypos decreased from 9 (T0) to 1 (T2) and 1 (T3); days-in-hospital from 7 (T0) to 0 (T2). No effect of age, gender, insulin regimen or puberty was found on HbA1C or time-in-hypo.

Conclusions: A benefit of tele-consultations in pediatric CGM patients was seen only in compliant patients with HbA1C > 7.5%. Targeted use of tele-consultations can increase CGM benefits.