Long-Term Glycemic Control Improvement After the Home andSelf-Care Program for Patients With Type 1 Diabetes:Real-World-Based Cohort Study

Background: The prevalence of type 1 diabetes (T1D) is increasing worldwide, with a much higher proportion of adult patients.However, achieving stable glycemic control is difficult in these patients. Objective: After periodic implementation of structured education for patients with T1D through the Home and Self-CareProgram, a pilot home health care project promoted by the Korean government, we evaluated the program's effects on glycemiccontrol. Methods: This study was conducted from April 2020 to March 2023. We analyzed 119 participants with T1D aged >15 years.Nursing and nutrition education were provided separately up to 4 times per year, with physician consultation up to 6 times peryear. A distinguishing feature of this study compared with previous ones was the provision of remote support using a general-purposesmartphone communication app offered up to 12 times annually on an as-needed basis to enhance the continuity of in-personeducation effects. Patients were followed up on at average intervals of 3 months for up to 24 months. The primary end point wasthe mean difference in glycated hemoglobin (HbA1c) at each follow-up visit from baseline. For continuous glucose monitoring(CGM) users, CGM metrics were also evaluated. Results: The mean HbA1clevel of study participants was 8.6% at baseline (mean duration of T1D 10.02, SD 16.10 y). TheHbA1clevel reduction in participants who received at least 1 structured educational session went from 1.63% (SD 2.03%; P<.001;adjustment model=1.69%, 95% CI 1.24%-2.13% at the first follow-up visit) to 1.23% (SD 1.31%; P=.01; adjustment model=1.28%,95% CI 0.78%-1.79% at the eighth follow-up visit). In the adjustment model, the actual mean HbA1cvalues were maintainedbetween a minimum of 7.33% (95% CI 7.20%-7.46% at the first follow-up visit) and a maximum of 7.62% (95% CI 7.41%-7.82%at the sixth follow-up visit). Among CGM users, after at least 1 session, the mean time in the target range was maintained between61.59% (adjusted model, 95% CI 58.14%-65.03% at the second follow-up visit) and 54.7% (95% CI 50.92%-58.48% at the eighthfollow-up visit), consistently staying above 54.7% (corresponding to an HbA1c level of <7.6%). The mean time below the targetrange (TBR) also gradually improved to the recommended range (<= 4% for TBR of <70 mg/dL and <= 1% for TBR of <54 mg/dL). Conclusions: The Home and Self-Care Program protocol for glycemic control in patients with T1D is effective, producingsignificant improvement immediately and long-term maintenance effects, including on CGM indexes.