O-34: The role of the cdces in designing an effective workflow for early AID initiation
J Leverenz, E Bailes, R Bell, F K Bishop, I Chan, B Conrad, D M Maahs, P Prahalad, R Tam, M Y LeeAbstract
Introduction
Diabetes technology, including continuous glucose monitor (CGM) and automated insulin delivery (AID), is standard of care for youth with type 1 diabetes (T1D). ISPAD guidelines recommend early initiation of diabetes technology. The 4T (Teamwork, Targets, Technology and Tight Glycemia) program supported early CGM initiation and protocolized an AID introduction class in the first 3 months after diagnosis. However, AID initiation remains persistently delayed. The Certified Diabetes Care and Education Specialist (CDCES) team launched a quality improvement program to accelerate AID initiation for newly diagnosed patients and families to expedite AID adoption.
Objectives
To develop a CDCES-led workflow starting youth on AID within the first month following T1D diagnosis.
Methods
Between October 2025 and April 2026, the 4T workflow was modified to offer early AID ≤1 month of T1D diagnosis. Standard of care includes visits for new-onset education, CGM initiation (within 1-2 weeks of diagnosis), CGM follow-up, and remote patient monitoring (RPM) of CGM data. The team iteratively refined the workflow to support unanticipated needs (Figure).
Results
The program enrolled 14 patients, including 57% male, 36% Other race, 21% Asian, 21% Black, 14% White, 71% Non-Hispanic, and 21% Hispanic, with a mean age of 6.5 ± 3.9 years. Ten participants (71%) initiated AID ≤14 days from diagnosis, and 13 (93%) initiated ≤1 month. Compared to the typical AID initiation visit duration of 1-2 hours for families who are >3 months from T1D diagnosis, CDCESs spent more time on AID initiation during this program (>2 hours in 93% visits).
Conclusions
As the standard of care advances, including earlier technology initiation and RPM, there are increased touchpoints for the CDCES to deliver education, insulin dose recommendations, and AID system adjustments. Newly diagnosed families can successfully initiate early AID with a strong CDCES team providing education and support.