Abstract: Remote Patient Monitoring in Youth with Type 1 Diabetes (T1D) Predicted to Experience a Rise in A1C%: Comparison to a Clinic-derived, Propensity Score-matched Controls
D. Williams1, D. Ferro2, E. Dewit2, B. Lockee2, M. Barnes2, S. Carrothers2, C. Vandervelden2, S. Patton3, R. Mcdonough2, L. D’Avolio4, M. Clements2
1Children’s Mercy Kansas City, Pediatrics, Kansas City, United States of America, 2Children’s Mercy Kansas City, Pediatric Endocrinology, Kansas City, United States of America, 3Nemours Children’s Health System, Nemours Center for Healthcare Delivery Science, Jacksonville, United States ofAmerica,4Cyft, Inc., Machine Learning, Cambridge, United States of America
Background and Aims: To determine if 1) remote patient monitoring (RPM) can improve glycemic control among youth with T1D who are predicted to experience a rise in A1c% using logistic regression and 2) propensity-score (PS) matching (PSM)RPM youth to non-RPM youth can control for confounding bias.
Methods: We collected data from 2-18-year-olds attending a tertiary care network of diabetes clinics in the Midwestern USA from 11/2018-9/2021. Eligible youth had baseline A1c%‡7.2, predicted 90-day rise in A1c%‡0.3 via advanced machine learning, and follow-up A1c% measured 70-180 days after baseline. Criteria used to calculate PS included sex, ethnicity, race, insurance, technologies, age, T1D duration, baseline A1c%, and predicted 90-day A1c% change. We compared each RPM-youth with three matched, non-RPM youth identified using a PS within–0.05.
Results: We matched 201 non-RPM youth to 67 RPM youth. The final cohort was 60% female, 4% Hispanic, 76% White, 54%private insurance, 37% on CGM and insulin pump, median age 13.4years (IQR=10.3,16.0), T1D duration 44.6 months (17.6,84.7), baseline A1c% 7.9 (7.5,8.8), and predicted 90-day A1c% change0.39 (0.33,0.48). After PSM, we found no significant differences for RPM and non-RPM youth (p’s=0.10-0.99), suggesting this method may be appropriate for creating a balanced clinic-derived control sample. However, 64% of RPM youth experienced no rise in A1c‡0.3% compared to 53% of non-RPM youth (p=0.10).
Conclusions: Youth receiving RPM may experience improved glycemic control relative to a clinic-derived control sample based on PSM, but these results require verification in a large multisite traditionally controlled study.