Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford.
Stanford Diabetes Research Center, Stanford, California, USA.
Curr Opin Pediatr. 2022 Aug 1;34(4):423-429. doi: 10.1097/MOP.0000000000001140.
The benefits of intensive diabetes management have been established by the Diabetes Control and Complications Trial. However, challenges with optimizing glycemic management in youth with type 1 diabetes (T1D) remain across pediatric clinics in the United States. This article will review our Teamwork, Targets, Technology, and Tight Control (4T) study that implements emerging diabetes technology into clinical practice with a team approach to sustain tight glycemic control from the onset of T1D and beyond to optimize clinical outcomes.
During the 4T Pilot study and study 1, our team-based approach to intensive target setting, education, and remote data review has led to significant improvements in hemoglobin A1c throughout the first year of T1D diagnosis in youth, as well as family and provider satisfaction.
The next steps include refinement of the current 4T study 1, developing a business case, and broader implementation of the 4T study. In study 2, we are including a more pragmatic cadence of remote data review and disseminating exercise education and activity tracking to both English- and Spanish-speaking families. The overall goal is to create and implement a translatable program that can facilitate better outcomes for pediatric clinics across the USA.
糖尿病控制和并发症试验已经证实了强化糖尿病管理的益处。然而，在美国的儿科诊所中，优化 1 型糖尿病（T1D）青少年的血糖管理仍然存在挑战。本文将回顾我们的团队合作、目标、技术和严格控制（4T）研究，该研究将新兴的糖尿病技术应用于临床实践，采用团队方法从 T1D 发病开始并持续进行严格的血糖控制，以优化临床结果。
在 4T 试点研究和研究 1 中，我们基于团队的强化目标设定、教育和远程数据审查方法，使青少年 T1D 诊断后的第一年的血红蛋白 A1c 显著改善，同时也提高了患者及其家属、医护人员的满意度。
下一步包括完善当前的 4T 研究 1、制定商业案例以及更广泛地实施 4T 研究。在研究 2 中，我们增加了更具实际意义的远程数据审查频率，并向英语和西班牙语患者家庭提供运动教育和活动跟踪。总体目标是创建和实施一个可翻译的项目，以促进美国各地儿科诊所的更好结果。
