A New Technology-Enabled Care Model for Pediatric Type 1 Diabetes
Open accessAbstract
In July 2018, pediatric type 1 diabetes (T1D) care at Stanford suffered many of the problems that plague U.S. health care. Patient outcomes lagged behind those of peer European nations, care was delivered primarily on a fixed cadence rather than as needed, continuous glucose monitors (CGMs) were largely unavailable for individuals with public insurance, and providers' primary access to CGM data was through long printouts. Stanford developed a new technology-enabled, telemedicine-based care model for patients with newly diagnosed T1D. They developed and deployed Timely Interventions for Diabetes Excellence (TIDE) to facilitate as-needed patient contact with the partially automated analysis of CGM data and used philanthropic funding to facilitate full access to CGM technology for publicly insured patients, for whom CGM is not readily available in California. A study of the use of CGM for patients with new-onset T1D (pilot Teamwork, Targets, and Technology for Tight Control [4T] study), which incorporated the use of TIDE, was associated with a 0.5%-point reduction in hemoglobin A1c compared with historical controls and an 86% reduction in screen time for providers reviewing patient data. Based on this initial success, Stanford expanded the use of TIDE to a total of 300 patients, including many outside the pilot 4T study, and made TIDE freely available as open-source software. Next steps include expanding the use of TIDE to support the care of approximately 1,000 patients, improving TIDE and the associated workflows to scale their use to more patients, incorporating data from additional sensors, and partnering with other institutions to facilitate their deployment of this care model.
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In another study at a US pediatric diabetes clinic, a team developed and implemented a patient prioritization algorithm using CGM data from patients with newly diagnosed T1D.
“In another study at a US pediatric diabetes clinic, a team developed and implemented a patient prioritization algorithm using CGM data from patients with newly diagnosed T1D [53,54].”
From Caregiver experiences of an integrative patient-centered digital health application for pediatric type 1 diabetes care: Findings from a pilot clinical trial (2025) · cites this paper as [54]
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Cites
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Self-citation
- Authors
- Scheinker, D., Prahalad, P., Johari, R., Maahs, D. M., & Majzun, R.
- Affiliations
- Lucile Packard Children's Hospital (US)
- Stanford University (US)
- Professor, Management Science and Engineering, Stanford University, Stanford, California, USA
- Venue
- NEJM Catalyst
- Publisher
- Massachusetts Medical Society
- Published
- 2022-04-20
- Volume
- 3
- Issue
- 5
- ISSN
- 2642-0007 (ISSN-L)
- PMC
- PMC9767424
- OpenAlex
- W4224307046
- Cited by
- 25
- References
- 15
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 9 · 2023: 4 · 2022: 3
- FWCI
- 4.08
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- NEJM Catalyst (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R18DK122422)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- type 1 diabetes in children, continuous glucose monitoring, telemedicine, models of care, tides, newly diagnosed diabetes, HbA1c, publicly insured patients, open source software, diabetes care delivery
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