The investigators hypothesize that REAL-Time Continuous Glucose Monitoring (RT-CGM) will be more effective if introduced in children and adolescents with established diabetes at the same time as they are starting pump therapy. This randomized controlled trial will compare the effectiveness of simultaneous vs delayed introduction of RT-CGM in children and adolescents with type 1 diabetes who are starting insulin pump therapy.

REAL-Time Continuous Glucose Monitoring (RT-CGM) improves diabetes control in adults with type 1 diabetes. However, studies of RT-CGM in children and adolescents have been mostly negative. The lack of effectiveness in the pediatric population appears directly related to adherence to RT-CGM, i.e., the willingness of children and teens to wear and use this technology. Most previous RT-CGM studies have focused on experienced pump users or children with new-onset diabetes. At the time of pump initiation, children and adolescents who have been living with diabetes (and their parents) are highly motivated to make changes in their diabetes management and to take on additional responsibilities to improve their diabetes control and lifestyle, the two primary reasons for initiating pump therapy in the pediatric population. The investigators hypothesize that readiness for making changes in diabetes management will be greater at the time of pump initiation than at six months after the pump start. Further, the investigators hypothesize that readiness for change at the time of RT-CGM initiation will predict future adherence to RT-CGM and its effectiveness.

Inclusion criteria:

• Males and females age 5-18 years old.
• Established T1D diagnosis for a minimum of one year.
• Naïve to CSII therapy and ready to start CSII with the Veo pump (Medtronic) .
• Willing to use RT-CGM and to be randomly assigned to either simultaneous or delayed RT-CGM initiation.
• Regular diabetes follow up at one of the 5 participating sites.
• Internet access at home (to upload RT-CGM data).
• Parent(s) or legally acceptable representative able to speak and read English or French.
• Ability of the subject and parent(s) or legally acceptable representative to participate in all aspects of this clinical trial.
• Written informed consent must be obtained and documented, with assent of the child if <14 years of age.

Exclusion Criteria

• Conditions which in the opinion of the investigator may interfere with the subject's ability to participate in the study.
• Has received oral and/or intravenous steroid therapy (for any indication, at any dose and/or for any duration) on more than 2 separate occasions in the past 12 months. Use of inhaled and/or topical steroid therapy in the last 12 months does not exclude the subject.
• Prior use of RT-CGM for more than 50% of the time over the past 6 months.
• Prior enrollment in the current study.
• Current enrollment in another intervention trial.