Early continuous glucose monitor use in children and adolescents with type 1 diabetes: rates of initiation and impact on glycemic outcomes

Objective

Early initiation of continuous glucose monitor (CGM) after type 1 diabetes diagnosis has been associated with lower hemoglobin A1c (HbA1c) in single-institution studies. This multi-center study evaluated the association between the timing of CGM initiation and HbA1c at 3 years post-diagnosis.

Research Design and Methods

Data were obtained from the T1D Exchange Quality Improvement Collaborative (T1DX-QI) electronic health record database from 25 pediatric centers and included children and adolescents ≤18 years old diagnosed with type 1 diabetes in 2019 and 2020. CGM initiation and glycemic outcomes were followed for 3 years after diagnosis. LOESS plots evaluated the relationship between timing of CGM initiation and HbA1c over time, and logistic regression models were used to adjust for potential confounders.

Results

There were 4,164 people included in this analysis, mean age was 12.6 (SD 3.5) years and 37% had public health insurance. Of the 93% (n=3,877) who initiated CGM within 3 years of T1D diagnosis, 21% did so at 0-3 months, 14% at 3-6 months, 14% at 6-12 months, and 51% after 12 months. Median HbA1c at 3 years post-diagnosis was lower for the 0-3 and 3-6 month groups compared to the 6-12 month and non-CGM user groups (7.9%, 7.9%, 8.4%, and 9.5%, respectively). Adjusted odds of HbA1c >9% were lowest for the 0-3 month group followed by the 3-6 month group.

Conclusions

In summary, early initiation of CGM within the first 6months of diagnosis is associated with improved HbA1c outcomes at 3 years post-diagnosis.