Introduction: Youth with type 1 diabetes (T1D) often do not achieve A1c target. This is especially problematic among Non-Hispanic Black (NHB) patients who may have less access to advanced technologies. To gain insight into ways to mitigate the disparity in glycemic outcome for high risk patients, we conducted a field trial of AID use among NHB youth with suboptimal A1c.
Methods: Self-identified NHB youth with T1D, aged 10-17, A1c 8-10%, ≥2 clinic visits in past year, no DKA for 6 mon, naive to AID, willing parent, access to video conferencing were invited to participate. Participants (pts) were instructed in use of Medtronic 670G Advanced Hybrid Closed Loop pump, by a CDCES nurse. The same nurse maintained at least once a week contact/support with the family for the first 4 wks. Thereafter, pts could elect to continue AID, plus have 1-on-1 enhanced availability of nurse support as needed/desired via video conference, phone or in person for another 5 mon, in addition to clinic follow up at 3 and 6 mon. The same nurse would initiate contact at least once a month if no contact had been made by the family.
Results: A total of 8 pts initially enrolled. One pt dropped out in the first wk. Remaining pts successfully initiated AID and agreed to continue beyond the first mon. One pt was discontinued after 3 mon due to inability to utilize AID safely. Three pts achieved lower A1c, 2 having A1c<8. While 4 pts had higher A1c compared to pre-AID. Overall group A1c and MBG during AID were similar to baseline. Factors potentially contributing to lack of improvement were reluctance to initiate/seek nurse contact, missing meal boluses, difficulty keeping system in automated mode.
Conclusions: Most pts preferred AID to prior insulin delivery mode and safely used it. However, access to AID and increased availability of staff support were not sufficient to improve overall glycemic control for this group. Innovations to increase pt support and facilitate AID use appear necessary to optimize glycemic outcome for high risk patients.
B. McConaughey: None. S. Chalew: None.
