Almost 30 years ago the Diabetes Control and Complications Trial demonstrated the benefit of intensive diabetes management to improve vascular outcomes and mortality. However, Pediatric Diabetes clinics have not achieved these HbA1c outcomes in practice. Advances in diabetes technology have been dramatic, but inequity in access to these technologies has increased disparities in diabetes outcomes in the US. Healthcare systems and processes of care can be challenges to achieving optimal outcomes. The Stanford Pediatric Diabetes team developed the Teamwork, Technology, and Targets for Tight Control: 4T Study to improve care and outcomes for children and adolescents newly diagnosed with type 1 diabetes (T1D). Background on outcomes including HbA1c and hypoglycemia, role of quality improvement, diabetes technology, and then methods and outcomes from the 4T Study will be reviewed. A goal of the 4T Study is to share and collaborate with other diabetes clinics materials and concepts developed to improve care and outcome for people with diabetes.