Scheduled remote review of continuous glucose monitoring data with targeted intervention vs standard care in children with Type 1 Diabetes: A parallel-groups study.

AIM: This study evaluated the impact of scheduled review of continuous glucose monitoring (CGM) data with targeted remote intervention on glycaemic and person-reported outcomes in children with type 1 diabetes (T1D). METHODS: Children aged 5-14 years with T1D using CGM were recruited from two metropolitan clinics at Perth Children's Hospital in Western Australia; one clinic group was assigned to intervention and the other to control. The intervention group underwent CGM review by a diabetes educator every 14-days. Participants with >10% decrease in time in range (TIR: 3.9-10.0 mmol/L) from the previous review period, or who were not meeting consensus CGM targets, were prioritised and offered personalised remote advice via phone or email; the number receiving contact was constrained based on allocated educator time in each 14-day period. Those improving or meeting targets received positive feedback by SMS. Change in TIR from baseline to 6 months was compared between groups using difference-in-difference analysis. Person-reported outcomes were assessed using Type 1 Diabetes and Life (T1DAL) and Diabetes Treatment Satisfaction (DTSQ) questionnaires. RESULTS: A total of 113 children were recruited, 60 in the intervention (53% male, age 10. 2(2.7) years, baseline TIR 66.9% (13.4), HbA1c 7.2% (1.3)) and 53 in the control (51% male, age 9.6 (2.6) years, baseline TIR 69.4% (13.4), HbA1c 6.9% (0.8)). Most participants used automated insulin delivery systems; 64% in the control and 72% in the intervention. Across 14-day periods, mean (95% CI) 71% (67, 75) of participants in the intervention group were identified for targeted support; 39% (30, 49) received remote advice. Positive feedback was sent to 38% (32, 43) in each 14-day period. Compared with the control group, the intervention group showed a non-significant 3.1 percentage point increase in time in range (β = 3.1, p = 0.11). Over six-months, mean TIR decreased in the control group (69.4% to 66.6%) and was unchanged in the intervention group (66.9% to 67.0%). No significant between-group differences were observed in T1DAL or DTSQ scores, limited by low end-of-intervention questionnaire response rates. CONCLUSIONS: Regular CGM review identified many participants not meeting CGM targets, and over half received targeted intervention. However, the intervention did not significantly improve TIR or person‑reported outcomes. While it did not bring participants into target range in this well‑controlled cohort, the model may have greater effect in children with lower baseline TIR. Future trials should evaluate its impact in higher‑risk youth.