A Framework for Scalable and Sustainable Remote Patient Monitoring in Type 1 Diabetes Care

Despite increasing use of continuous glucose monitoring (CGM) and automated insulin delivery, most children and adolescents living with type 1 diabetes (T1D) in the US do not achieve recommended glycemic targets. Structured, proactive support improves glycemic outcomes, but diabetes teams have historically lacked reimbursement pathways and scalable workflows to support between-visit care. The introduction of remote patient monitoring (RPM) billing codes has created new opportunities to align clinical need with care delivery models, although adoption remains limited. We describe implementation experiences from three pediatric diabetes centers that developed RPM programs across distinct clinical populations and institutional environments. Each site developed workflows for data review, patient outreach, documentation, and billing, supported by digital platforms designed to facilitate population-level management. Common themes emerged around needs for structured patient onboarding, multidisciplinary team alignment, standardized documentation, efficient data aggregation and population health management tools, adaptable communication pathways, and financial alignment. This practice-informed commentary synthesizes common themes across these programs and outlines key considerations for RPM implementation, including workflow design, digital infrastructure, communication strategies, and reimbursement structures. We also highlight practical challenges related to equity, patient engagement, and operational feasibility. This report aims to contextualize early clinical experience with RPM and identify factors that may influence its integration into pediatric diabetes care.