1358-P: Early CGM Initiation in New-Onset Type 1 Diabetes Patients

A minority of children and adolescents with T1D meet HbA1c targets as recommended in the ADA guidelines. We have previously shown that in our clinic there is a sharp inflection point in HbA1c trajectory starting between 5 and 6 months of diagnosis with a rise in HbA1c from 7.0 ± 1.5% at 5 months post-diagnosis to 8.0 ± 1.7% at 12 months post-diagnosis. Given the benefits of CGM and improved CGM technology, we started a clinical program to initiate CGM therapy within the first month of diabetes diagnosis aimed at decreasing the rise in HbA1c that occurs over the first year of diagnosis. Since initiating this program in August 2018, 20 youth with T1D were started on the Dexcom G6 CGM system within the first month of diagnosis (average time to start is 8.5 ± 1.3 days post-diagnosis, 3 declined CGM initiation). The average age at T1D onset was 10.1 ± 0.8 years and 50% presented in DKA. Mean HbA1c at diagnosis was 12.0 ± 4.0%. In this cohort, 45% were male, 50% non-Hispanic white, 85% had private insurance, and 85% spoke English as the primary language. A majority of clinic patients used the mobile phone as their CGM receiver (73%) and all of these individuals used the Share feature. A majority of clinic patients (75%) have had at least 2 follow-up visits. By the second follow-up visit (46.1 ± 3.9 days since CGM start), patients were wearing the CGM on average of 94.5 ± 5.9% of the days over the last 2 weeks. Of the 20 individuals initially started on CGM, 3 were no longer using it at the time of their most recent visit. Two of the individuals had issues with insurance coverage and the third had issues with the transmitter. The incidence of hypoglycemia was low (2.2 ± 0.7%) and the patients had a time in range (TIR, glucose 70 - 180 mg/dL) of 71.1 ± 4.6%. In our cohort, patients continued to use CGM with a high percent of wear time. Although we do not have a control or comparison group, our population had a low incidence of hypoglycemia and high percentage of TIR. These data suggest that CGM can be successfully started within 2 weeks of T1D diagnosis with potential benefits on glucose control.