Applying 4T Study Findings to the Managed Care Space: Dr David Maahs


David Maahs, MD, PhD, professor of pediatrics at Stanford University and division chief of pediatric endocrinology at Lucile Packard Children’s Hospital, talks about the Timely Interventions for Diabetes Excellence dashboard, increases in continuous glucose monitoring, and more.

In the previous installment of this interview, David Maahs, MD, PhD, professor of pediatrics at Stanford University and division chief of pediatric endocrinology at Lucile Packard Children’s Hospital, revealed key findings and takeaways from the pilot 4T study, which focuses on teamwork, targets, technology, and tight control in newly diagnosed type 1 diabetes (T1D). Here, Maahs talks about how these findings can be applied in the managed care space, and what other trends he has noticed since the study's publication.


How can findings from the 4T study be applied in the managed care space?

What we're trying to do now is take the program that we've developed at Stanford and share it with other programs to see if this is something that can help other diabetes clinics and people with diabetes in other parts of the world. So we're very eager to share this. We think that it has shown that it decreases hemoglobin A1C while not increasing hypoglycemia. We think it shows that equitable access to diabetes technology can benefit all.

We also have worked with our engineering colleagues to create this system with our certified diabetes care and education specialists that we're calling the TIDE dashboard—or Timely Interventions for Diabetes Excellence—and that system helps prioritize, based on the data from people with diabetes, who needs attention in between visits so that our diabetes educators can reach out and help them when they need it. Now, they don't reach out in real time, they're doing evaluations every week, but that's still better than what currently is about an every 3 month tempo at which we see patients in clinical visits, either in person or via telehealth. So I think there is some good promise. I think this system helps make the review of all this glucose data that comes in more efficient and help prioritize who most needs help with it. So we think there's promise for this to expand and to help other people as well.

Since the 4T study was published, have you noticed any new trends in youth T1D care?

Continuous glucose monitoring (CGM) continues to increase across the US and across other countries. I think there was a very encouraging paper in the last year from Australia, where they have universal access to CGM for children and adolescents with type 1 diabetes. And what that paper showed is that there was, again, an improvement in hemoglobin A1C and also reduction in diabetic ketoacidosis and reduction in hypoglycemia. I think it really sets the bar for other countries to try to achieve universal access to these diabetes technologies, which are clearly shown to improve outcomes for people with diabetes as well as reducing the burden of care. I think in the US, that's something we are still working on. I think it's something we need to prioritize. I think all people with type 1 diabetes should have access to the best possible diabetes technology, the best possible care.

Right now, we're at a point where it's A level evidence to use automated insulin delivery—that's per the American Diabetes Association and also ISPAD, or the International Society of Pediatric and Adolescent Diabetes—and so the data are very clear that you get better outcomes, better glucose values, if you are using these automated insulin delivery systems.

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