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内分泌学中持续葡萄糖监测应用及改善结局路线图:4T(团队合作、目标、技术和严格控制)计划

Roadmap to Continuous Glucose Monitoring Adoption and Improved Outcomes in Endocrinology: The 4T (Teamwork, Targets, Technology, and Tight Control) Program.

作者信息

Prahalad Priya, Maahs David M

机构信息

Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA.

Stanford Diabetes Research Center, Stanford University, Stanford, CA.

出版信息

Diabetes Spectr. 2023 Fall;36(4):299-305. doi: 10.2337/dsi23-0003. Epub 2023 Nov 15.

Abstract

Glucose monitoring is essential for the management of type 1 diabetes and has evolved from urine glucose monitoring in the early 1900s to home blood glucose monitoring in the 1980s to continuous glucose monitoring (CGM) today. Youth with type 1 diabetes struggle to meet A1C goals; however, CGM is associated with improved A1C in these youth and is recommended as a standard of care by diabetes professional organizations. Despite their utility, expanding uptake of CGM systems has been challenging, especially in minoritized communities. The 4T (Teamwork, Targets, Technology, and Tight Control) program was developed using a team-based approach to set consistent glycemic targets and equitably initiate CGM and remote patient monitoring in all youth with new-onset type 1 diabetes. In the pilot 4T study, youth in the 4T cohort had a 0.5% improvement in A1C 12 months after diabetes diagnosis compared with those in the historical cohort. The 4T program can serve as a roadmap for other multidisciplinary pediatric type 1 diabetes clinics to increase CGM adoption and improve glycemic outcomes.

摘要

血糖监测对于1型糖尿病的管理至关重要,其已从20世纪初的尿糖监测发展到20世纪80年代的家庭血糖监测,直至如今的持续葡萄糖监测(CGM)。1型糖尿病青少年难以实现糖化血红蛋白(A1C)目标;然而,CGM与这些青少年A1C的改善相关,并且被糖尿病专业组织推荐为一种护理标准。尽管CGM系统有其效用,但扩大其使用一直具有挑战性,尤其是在少数族裔社区。4T(团队合作、目标、技术和严格控制)项目采用基于团队的方法来设定一致的血糖目标,并公平地为所有新诊断的1型糖尿病青少年启动CGM和远程患者监测。在4T试点研究中,与历史队列中的青少年相比,4T队列中的青少年在糖尿病诊断后12个月时A1C改善了0.5%。4T项目可以作为其他多学科儿科1型糖尿病诊所增加CGM采用率和改善血糖结果的路线图。

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