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Objective: While frequent contact with diabetes care providers may improve glycemic control among patients with type 1 diabetes (T1D), in‐person visits are labor‐intensive and costly. This study was conducted to assess the impact of an intensive remote therapy (IRT) intervention for pediatric patients with T1D. Methods: Pediatric patients with T1D were randomized to IRT or conventional care (CC) for 6 months. Both cohorts continued routine quarterly clinic visits and uploaded device data; for the IRT cohort, data were reviewed and patients were contacted if regimen adjustments were indicated. Glycated hemoglobin (HbA1c) change from baseline was assessed at 6 and 9 months. Diabetes‐related quality of life (QoL), healthcare services utilization, and hypoglycemic events were also tracked. Results: Among 117 enrollees (60 IRT, 57 CC), mean (SD) 6‐month %HbA1c change for IRT vs CC was −0.34 (0.85) (−3.7 mmol/mol) vs −0.05 (0.74) (−0.5 mmol/mol) overall (P = .071); −0.15 (0.67) (1.6 mmol/mol) vs −0.02 (0.66) (0.2 mmol/mol) for ages 8 to 12 (P = .541); and −0.50 (0.95) (−5.5 mmol/mol) vs −0.06 (0.80) (−0.7 mmol/mol) for ages 13 to 17 (P = .056). Diabetes‐related QoL increased by 6.5 and 1.3 points for IRT and CC, respectively (P = .062). Three months after intervention cessation, %HbA1c changed minimally among treated children aged 8 to 12 but increased by 0.22 (0.89) (2.4 mmol/mol) among those aged 13 to 17. Conclusions: IRT substantially affected diabetes metrics and improved QoL among pediatric patients with T1D. Adolescents experienced a stronger treatment effect, but had difficulty in sustaining improved control after intervention cessation. [ABSTRACT FROM AUTHOR]