REMOTE MONITORING OF CGM DATA FOLLOWED BY TELE-CONSULTATIONS IN A PEDIATRIC TYPE 1 DIABETES POPULATION: CHOOSING THE RIGHT PATIENTS TO ACHIEVE VALUE BASED HEALTH-CARE
Gies I1, Vanbesien J1, Hansart A1, Hamddan Lachkar M1, Devisscher C1, Vermeulen B². 
1Dept of Pediatrics, UZ Brussel, Brussels, Belgium; ²IDLab, imec-UGent, Gent, Belgium. 

Background and aims
Improvement of metabolic outcome must be balanced against the economic burden of CGM use. We wanted to characterize whether CGM use can be leveraged by tele-consultations. 
Methods
CGM data from 47 T1DM patients (3-18 years) on Guardian Connect were automatically uploaded in the hospital files between April and October 2017. Bi-weekly tele-consultations were implemented. Patients were divided into a compliant group, following the insulin treatment changes, and an uncompliant group. HbA1C, time-in-hypo, days-in-hospital and QOL (DQOLY questionnaire) were measured in a cross-over study investigating 6 months before tele-consultations (T0),  3 and 6 months with tele-consultations (T1;T2),  and  6 months without tele-consultations after a 6 months washout period (T3).
Results
Baseline HbA1C(±SD) for the total group was 7.7±1% and did not change significantly; time-in-hypo decreased from 8±5%(T0) to 5±3%(T2)(p=0.002) and increased to 6±4%(T3)(p=0.143). HbA1C of patients with HbA1C > 7.5% at T0 decreased significantly from 8.3±0.6% to 8±0.7% at T1(p=0.024), to 8.1±1% at T2(p=0.176) and increased to 8.3±0.9 at T3(p=0.495). In compliant patients(n=8) with baseline HbA1C >7.5%, HbA1C changed significantly from 8.1±0.5%(T0) to 7.6±0.4%(T1)(p=0.029), 7.3±0.3% atT2 (p=0.001), and to 7.9±0.9% at T3(p=0.035). Number of serious hypos in this group decreased from 9(T0) to 1(T2) and 1(T3);days-in-hospital (for diabetes) from 7(T0) to 0(T2 and T3). QOL did not change significantly. 
Conclusions
A real benefit from tele-consultations in pediatric CGM patients was only seen  in compliant patients with HbA1C above 7.5%. Targeted use of tele-consultations can increase the metabolic and economic benefit of CGM use.

REMOTE MONITORING OF CGM DATA FOLLOWED BY TELE-CONSULTATIONS IN A PEDIATRIC TYPE 1 DIABETES POPULATION: CHOOSING THE RIGHT PATIENTS TO ACHIEVE VALUE BASED HEALTH-CARE.