Teamwork, targets, technology, and tight control in newly diagnosed type 1 diabetes: the Pilot 4T Study
Open accessAbstract
Context: Youth with type 1 diabetes (T1D) do not meet glycated hemoglobin A1c (HbA1c) targets. Objective: This work aimed to assess HbA1c outcomes in children with new-onset T1D enrolled in the Teamwork, Targets, Technology and Tight Control (4T) Study. Methods: HbA1c levels were compared between the 4T and historical cohorts. HbA1c differences between cohorts were estimated using locally estimated scatter plot smoothing (LOESS). The change from nadir HbA1c (month 4) to 12 months post diagnosis was estimated by cohort using a piecewise mixed-effects regression model accounting for age at diagnosis, sex, ethnicity, and insurance type. We recruited 135 youth with newly diagnosed T1D at Stanford Children’s Health. Starting July 2018, all youth within the first month of T1D diagnosis were offered continuous glucose monitoring (CGM) initiation and remote CGM data review was added in March 2019. The main outcomes measure was HbA1c. Results: HbA1c at 6, 9, and 12 months post diagnosis was lower in the 4T cohort than in the historic cohort (–0.54% to –0.52%, and –0.58%, respectively). Within the 4T cohort, HbA1c at 6, 9, and 12 months post diagnosis was lower in those patients with remote monitoring than those without (–0.14%, –0.18% to –0.14%, respectively). Multivariable regression analysis showed that the 4T cohort experienced a significantly lower increase in HbA1c between months 4 and 12 (P < .001). Conclusion: A technology-enabled, team-based approach to intensified new-onset education involving target setting, CGM initiation, and remote data review statistically significantly decreased HbA1c in youth with T1D 12 months post diagnosis.
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Compared to a historical cohort of newly diagnosed T1D patients not using CGM, those using CGM had lower HbA1C levels at 6-, 9-, and 12-months post-diagnosis.
“Compared to a historical cohort of newly diagnosed T1D patients not using CGM, those using CGM had lower HbA1C levels at 6-, 9-, and 12-months post-diagnosis.”
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 [53]
The ‘Glycated Hemoglobin A1c Differences Between Cohorts’ section reports lower mean HbA1c in the Pilot 4T cohort at 6, 9, and 12 months. But the ‘Cohort Descriptions’ section says 56.2% of the historical cohort started CGM, so describing that cohort as not using CGM is inaccurate. The comparison was between cohorts with different approaches to CGM initiation, not CGM users versus nonusers. (LLM, conf=0.90)
Experimental — accuracy not yet measuredAmong CGM users, those who also received HCP-guided remote monitoring had even lower HbA1C levels, highlighting the added benefit of HCP involvement in digital tool use.
“Among CGM users, those who also received HCP-guided remote monitoring had even lower HbA1C levels, highlighting the added benefit of HCP involvement in digital tool use [53].”
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 [53]
The Glycated Hemoglobin A1c Differences Between Cohorts section reports lower mean HbA1c among Pilot 4T participants who received remote monitoring than among those who did not. The Discussion says this difference was not statistically significant and describes the further improvement as possible, so the claim overstates the evidence for an added benefit of HCP involvement. Page numbers are not provided in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn 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 [53]
In youth with type 1 diabetes, starting CGM soon after diagnosis lowers A1C and is associated with high parental satisfaction and reliance on CGM for diabetes management.
“In addition, early CGM initiation after diagnosis of type 1 diabetes in youth has been shown to decrease A1C levels and is associated with high parental satisfaction and reliance on this technology for diabetes management (5,6).”
From 7. Diabetes Technology: Standards of Care in Diabetes—2025 (2025) · cites this paper as [5]
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References 46 · Cited by 82
- Authors
- Prahalad, P., Ding, V. Y., Zaharieva, D. P., Addala, A., Johari, R., Scheinker, D., Desai, M., Hood, K., & Maahs, D. M.
- Affiliations
- Stanford Medicine (US)
- Stanford University (US)
- Stanford Diabetes Research Center, Stanford University, Stanford, California 94304, USA
- Corresponding author
- Prahalad, Priya
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2021-11-28
- Volume
- 107
- Issue
- 4
- Pages
- 998-1008
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC8947228
- OpenAlex
- W3215753986
- Cited by
- 82
- References
- 46
- Citations by year
- 2026: 13 · 2025: 18 · 2024: 19 · 2023: 18 · 2022: 13 · 2021: 1
- FWCI
- 9.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (P30DK116074)
- Stanford Diabetes Research Center (R18DK122422)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 1 diabetes, newly diagnosed diabetes, HbA1c, HbA1c control, continuous glucose monitoring, diabetes education, team-based care, glycemic targets, youth, children, diabetes self-management
- MeSH terms
- Adolescent, Blood Glucose, Child, Diabetes Mellitus, Type 1, Glycated Hemoglobin, Humans, Technology, Blood Glucose Self-Monitoring
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