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Health care inequities among racial and ethnic groups remain prevalent. For people with type 1 diabetes who require increased medical access and care, disparities are seen in access to care and health outcomes. This article reports on a study by the T1D Exchange Quality Improvement Collaborative evaluating differences in A1C, diabetic ketoacidosis (DKA), severe hypoglycemia, and technology use among racial and ethnic groups. In a diverse cohort of nearly 20,000 children and adults with type 1 diabetes, A1C was found to differ significantly among racial and ethnic groups. Non-Hispanic Blacks had higher rates of DKA and severe hypoglycemia and the lowest rate of technology use. These results underscore the crucial need to study and overcome the barriers that lead to inequities in the care and outcomes of people with type 1 diabetes.

ObjectiveWe examined whether diabetic ketoacidosis (DKA), a serious complication of type 1 diabetes (T1D) was more prevalent among Non-Hispanic (NH) Black and Hispanic patients with T1D and laboratory-confirmed coronavirus disease 2019 (COVID-19) compared with NH Whites.MethodThis is a cross-sectional study of patients with T1D and laboratory-confirmed COVID-19 from 52 clinical sites in the United States, data were collected from April to August 2020. We examined the distribution of patient factors and DKA events across NH White, NH Black, and Hispanic race/ethnicity groups. Multivariable logistic regression analysis was performed to examine the odds of DKA among NH Black and Hispanic patients with T1D as compared with NH White patients, adjusting for potential confounders, such as age, sex, insurance, and last glycated hemoglobin A1c (HbA1c) level.ResultsWe included 180 patients with T1D and laboratory-confirmed COVID-19 in the analysis. Forty-four percent (n = 79) were NH White, 31% (n = 55) NH Black, 26% (n = 46) Hispanic. NH Blacks and Hispanics had higher median HbA1c than Whites (%-points [IQR]: 11.7 [4.7], P

OBJECTIVE: To compare demographic, clinical, and therapeutic characteristics of children with type 1 diabetes age <6 years across three international registries: Diabetes Prospective Follow-Up Registry (DPV; Europe), T1D Exchange Quality Improvement Network (T1DX-QI; U.S.), and Australasian Diabetes Data Network (ADDN; Australasia). RESEARCH DESIGN AND METHODS: An analysis was conducted comparing 2019–2021 prospective registry data from 8,004 children. RESULTS: Mean ± SD ages at diabetes diagnosis were 3.2 ± 1.4 (DPV and ADDN) and 3.7 ± 1.8 years (T1DX-QI). Mean ± SD diabetes durations were 1.4 ± 1.3 (DPV), 1.4 ± 1.6 (T1DX-QI), and 1.5 ± 1.3 years (ADDN). BMI z scores were in the overweight range in 36.2% (DPV), 41.8% (T1DX-QI), and 50.0% (ADDN) of participants. Mean ± SD HbA1c varied among registries: DPV 7.3 ± 0.9% (56 ± 10 mmol/mol), T1DX-QI 8.0 ± 1.4% (64 ± 16 mmol/mol), and ADDN 7.7 ± 1.2% (61 ± 13 mmol/mol). Overall, 37.5% of children achieved the target HbA1c of <7.0% (53 mmol/mol): 43.6% in DPV, 25.5% in T1DX-QI, and 27.5% in ADDN. Use of diabetes technologies such as insulin pump (DPV 86.6%, T1DX 46.6%, and ADDN 39.2%) and continuous glucose monitoring (CGM; DPV 85.1%, T1DX-QI 57.6%, and ADDN 70.5%) varied among registries. Use of hybrid closed-loop (HCL) systems was uncommon (from 0.5% [ADDN] to 6.9% [DPV]). CONCLUSIONS: Across three major registries, more than half of children age <6 years did not achieve the target HbA1c of <7.0% (53 mmol/mol). CGM was used by most participants, whereas insulin pump use varied across registries, and HCL system use was rare. The differences seen in glycemia and use of diabetes technologies among registries require further investigation to determine potential contributing factors and areas to target to improve the care of this vulnerable group. [ABSTRACT FROM AUTHOR]

The article focuses on the T1D Exchange's efforts to advance outcomes in type 1 diabetes care through collaborative change. The topics includes the persistent disparities in diabetes technology use, the impact of regional and racial/ethnic variations, and initiatives to address inequities in diabetes technology utilization.

Social determinants of health (SDOH) are strongly associated with outcomes for people with type 1 diabetes. Six centers in the T1D Exchange Quality Improvement Collaborative applied quality improvement principles to design iterative Plan-Do-Study-Act cycles to develop and expand interventions to improve SDOH screening rates. The interventions tested include staff training, a social risk index, an electronic health record patient-facing portal, partnerships with community organizations, and referrals to community resources. All centers were successful in improving SDOH screening rates, with individual site improvements ranging from 41 to 70% and overall screening across the six centers increasing from a baseline of 1% to 70% in 27 months. [ABSTRACT FROM AUTHOR]

Screening for autoantibodies associated with type 1 diabetes can identify people most at risk for progressing to clinical type 1 diabetes and provide an opportunity for early intervention. Drawbacks and barriers to screening exist, and concerns arise, as methods for disease prevention are limited and no cure exists today. The availability of novel treatment options such as teplizumab to delay progression to clinical type 1 diabetes in high-risk individuals has led to the reassessment of screening programs. This study explored awareness, readiness, and attitudes of endocrinology providers toward type 1 diabetes autoantibody screening. [ABSTRACT FROM AUTHOR]

Despite the benefits of continuous glucose monitoring (CGM), there is lower use of this technology among non-Hispanic Black and Hispanic people with type 1 diabetes compared with their non-Hispanic White counterparts. The T1D Exchange Quality Improvement Collaborative recruited five endocrinology centers to pilot an equity-focused quality improvement (QI) study to reduce racial inequities in CGM use. The centers used rapid QI cycles to test and expand interventions such as provider bias training, translation of CGM materials, provision of CGM education in multiple languages, screening for social determinants of health, and shared decision-making. After implementation of these interventions, median CGM use increased by 7% in non-Hispanic White, 12% in non-Hispanic Black, and 15% in Hispanic people with type 1 diabetes. The gap between non-Hispanic White and non-Hispanic Black patients decreased by 5%, and the gap between non-Hispanic White and Hispanic patients decreased by 8%. [ABSTRACT FROM AUTHOR]

The T1D Exchange Quality Improvement Collaborative (T1DX-QI) is a network of over 55 diabetes centers that aims to improve diabetes care and outcomes for individuals with type 1 diabetes (T1D). The network focuses on refining best practices, emphasizing quality of care, and using real-world data to drive improvements. The November 2023 conference highlighted various topics, including psychosocial aspects of care and improving technology advancement and access. The abstracts presented at the conference covered a range of subjects, such as screening for eating disorders and anxiety, implementing social determinants of health screening, identifying barriers to technology use, and exploring remote patient monitoring. The T1DX-QI Collaborative continues to work towards improving overall health outcomes, reducing complications, and closing health equity gaps for people living with T1D. [Extracted from the article]

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an effort to improve the remote collection of insulin pump data in an academic center in South Florida. [ABSTRACT FROM AUTHOR]

This study sought to identify barriers and facilitators to successful smart insulin pen (SIP) use and gauge prescribing practices and integration into clinical practice by assessing provider and care team perspectives at participating endocrinology clinics within the T1D Exchange Quality Improvement Collaborative. The identified provider-related, patient-related, and clinic- and operational-level barriers and facilitators varied based on clinic knowledge, capacity, and resources. High-impact barriers included insurance coverage and prescribing processes; high-impact facilitators included improved diabetes clinic visit quality and use of SIPs as an alternative to insulin pump therapy. Findings indicated the need for provider and care team education and training on proper SIP features, use, and prescribing. [ABSTRACT FROM AUTHOR]

This article describes the evolution of the Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI) and provides insight into the development and growth of a successful type 1 diabetes quality improvement (QI) program. Since its inception 8 years ago, the collaborative has expanded to include centers across the United States with varying levels of QI experience, while simultaneously achieving many tangible improvements in type 1 diabetes care. These successes underscore the importance of learning health systems, data-sharing, benchmarking, and peer collaboration as drivers for continuous QI. Future efforts will include recruiting additional small- to medium-sized centers focused on adult care and underserved communities to further the goal of improving care and outcomes for all people living with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Many adults with diabetes do not reach optimal glycemic targets, and, despite advances in diabetes management, diabetes technology use remains significantly lower in racial/ethnic minority groups. This study aimed to identify factors associated with achieving the recommended A1C target of <7% using data on 12,035 adults with type 1 diabetes from 15 centers participating in the T1D Exchange Quality Improvement Collaborative. Individuals attaining the target A1C were more likely to be older, White, have private health insurance, and use diabetes technology and less likely to report depressive symptoms or episodes of severe hypoglycemia or diabetic ketoacidosis than those with higher A1C levels. These findings highlight the importance of overcoming inequities in diabetes care. [ABSTRACT FROM AUTHOR]

The article reports that T1D Exchange Quality Improvement Collaborative is a framework used to systematically improve systems and processes. Topics include examines it was established in 2016 and continued to evolve throughout several years and considered in health care settings, the T1DX-QI allows health care professionals, patients with type 1 diabetes and families to be part of a process that evaluates and improves many areas of health care for everyone who touches the health care system.

Keywords: learning health systems; quality improvement; real world evidence; type 1 diabetes EN learning health systems quality improvement real world evidence type 1 diabetes 83 87 5 01/10/22 20220101 NES 220101 INTRODUCTION Since the discovery of insulin 100 years ago, there have been continual advances in medications and technologies for the management of type 1 diabetes (T1D). The sharing of data in the T1DX-QI database informs QI-based population health interventions to improve outcomes. QI, quality improvement; T1D, type 1 diabetes; T1DX-QI, T1D Exchange Quality Improvement Collaborative gl In this commentary, we describe the goals of the T1DX-QI and highlight QI and population health conference abstracts recently presented at the 2021 T1DX-QI conference. [Extracted from the article]

2020; 27 (6): 256 - 259. doi: 10.12788/jcom.0031 19 Alonso, GT, Rioles, N & Ebekozien, O. A population health data platform to improve outcomes in the T1D exchange quality improvement collaborative (T1DX-QI). GLO:55QH/01jan22:jdb13235-fig-0001.jpg PHOTO (COLOR): 1 Key driver diagram describing T1D exchange health equity program gl T1DX-QI APPROACHES TO ADDRESSING HEALTH INEQUITIES IN THE UNITED STATES Identify inequities with real-world EMR data The T1DX-QI uses its unique EMR database with de-identified data on over 35 000 people with T1D to perform population health analysis. Keywords: disparities; health equity; quality improvement; real-world evidence; solution; type 1 diabetes EN disparities health equity quality improvement real-world evidence solution type 1 diabetes 79 82 4 01/10/22 20220101 NES 220101 GLO:55QH/01jan22:jdb13235-toc-0001.jpg PHOTO (COLOR): . gl INTRODUCTION Approximately 1.6 million people in the United States have type 1 diabetes (T1D).1 The incidence of T1D is increasing in the United States across all populations, most significantly among Hispanic and non-Hispanic Black (NHB) patients.2,3 Unfortunately, widespread inequities exist in health outcomes among patients with T1D in the United States.4-7 In 2016, the T1D Exchange Quality Improvement Collaborative (T1DX-QI) was established.8 T1DX-QI is a learning health network9 with over 40 centers across the United States. [Extracted from the article]