1200-P: Effectiveness of Real-Time, Remote Continuous Glucose Monitoring in Adolescents with Poorly Controlled Type 1 Diabetes

Introduction & Objective: Adolescents with Type 1 diabetes (T1D) have higher hemoglobin A1c (A1c) than other age groups. Poorly controlled diabetes increases the risk for diabetic ketoacidosis (DKA) and other diabetic complications. We hypothesized that real-time, remote, continuous glucose monitoring with real-time coaching via two-way text messaging will improve the A1c of adolescents with poorly controlled T1D.

Methods: We are conducting a prospective, single-arm, pilot study. Phase 1 is a run-in phase using a continuous glucose monitor (CGM). Phase 2 consists of 3 months of real-time, remote, glucose monitoring (RTM) with two-way text messaging with a pediatric endocrinologist to provide coaching, glucose trend review and insulin dose adjustments. During the 3-month final phase, we assess A1c changes after cessation of RTM. We also follow psychosocial measures. Inclusion criteria include patients with T1D ages 13 to 18 years, with 30% annual risk of developing DKA or A1c ≥ 12%. Primary exclusion criteria include other types of diabetes and chronic conditions or use of glucocorticoids that affect glycemic control.

Results: Nine participants began the RTM phase. One participant had a malfunctioning phone, which adversely impacted CGM data sharing. Therefore, the corresponding data were not included in the results. Average baseline A1c was 11.4%. Following 3 months of RTM, A1c improved by 0.7% (p = 0.15). Alc increased after cessation of RTM. Time in range improved an average of 1.8% during RTM but decreased during Phase 3. Participants with greater correspondence frequency with the monitoring physician had greater improvement in A1c (decreased by 1.6-3%). During the study, no participants were admitted for DKA.

Conclusion: RTM and coaching improved the overall glycemic control of our pilot study participants. However, the improvement was not sustained without RTM. The level of return engagement might be associated with some level of improvement in A1c.