1188-P: Sustained Improvements in Glycemia over Three Years in the Teamwork, Targets, Technology, and Tight Control (Pilot 4T) Study

In the Pilot 4T Study (diagnosed 2018-2020), youth with new onset T1D were started on CGM in the first month of diagnosis, had tight glucose targets (A1c<7.5%, 2018 ADA target) and received remote patient monitoring (RPM). Youth had a 0.5% A1c reduction compared to historical controls (diagnosed 2014-2016) at 12 months post-diagnosis. We hypothesized that A1c would remain lower in the Pilot 4T cohort vs. the historical cohort over three years.

A1c data were available for 88% (historical) and 75% (Pilot 4T) at 24 <u>+</u> 1.5 months and 80% (historical) and 61% (Pilot 4T) at 36 <u>+</u> 1.5 months post-diagnosis. Population-based A1c trajectories over three years in the historical and Pilot 4T were visualized using locally estimated scatter plot smoothing (LOESS; Fig 1). Mean A1c at diagnosis was higher in Pilot 4T (12.3±2.1%) than in the historical cohort (10.9±2.5%). At 18, 24, 30, and 36 months post-diagnosis, the Pilot 4T cohort had LOESS-based mean A1c of 0.72, 0.78, 0.95, and 1.09 percentage points lower than the historical cohort.

Fewer A1c data points were available in the Pilot 4T cohort, likely due to increased telehealth during the COVID-19 pandemic. The 4T program (teamwork, tight glucose targets, early CGM initiation with RPM) was associated with lower A1c during the first 36 months post-diagnosis compared to historic interventions, further supporting 4T adoption in all youth with new onset T1D.

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