DYNAMIC : DYNA mic glucose M anagement strategies delivered through a structured education program improves time I n range in a socioeconomically deprived cohort of C hildren and young people with type 1 diabetes with a history of hypoglycaemia

OBJECTIVES Create and evaluate the effectiveness of a structured education program in children and young people (CYP) with type 1 diabetes using continuous glucose monitoring (CGM). DESIGN & METHODS Step 1: CGM devices were evaluated for pre-determined criteria using a composite score. Step 2: The education program was developed following review of international structured education guidance, dynamic glucose management (DynamicGM) literature, award-winning diabetes educators' websites and CGM user feedback. Step 3: Program effectiveness was assessed at six months by change in time below range (TBR) ( 13.9mmol/L), severe hypoglycaemia and HbA1c using a paired T-test. A DynamicGM score was developed to assess proactive glucose management. Factors predicting TBR and TIR were assessed using regression analysis. RESULTS Dexcom G6 was chosen for integrated CGM (iCGM) status and highest composite score (29/30). Progressive DynamicGM strategies were taught through five sessions delivered over two months. Fifty CYP (23 male) with a mean (±SD) age and diabetes duration of 10.2 (±4.8) and 5.2 (±3.7) years respectively, who completed the education program were prospectively evaluated. Evaluation at six months showed a significant reduction in TBR (10.4% to 2.1%, p<0.001), TAR2 (14.1% to 7.3%, p<0.001), HbA1c [7.4 to 7.1% (57.7 to 53.8 mmol/mol), p<0.001] and severe hypoglycaemic episodes (10 to 1, p<0.05); TIR increased (47.4% to 57.0%, p<0.001). Number of Dexcom followers (p<0.05) predicted reduction in TBR and DynamicGM score (p<0.001) predicted increased TIR. CONCLUSION Teaching DynamicGM strategies successfully improves TIR and reduces hypoglycaemia. This article is protected by copyright. All rights reserved.