The T1D Exchange team is honored to share 9 presentations at the 47th Annual International Society for Pediatric and Adolescent Diabetes (ISPAD) Conference, held virtually October 13-15, 2021! Although the meeting is virtual, it has brought together members of the research community from all over the world to participate in the program.

Read more about the presentations from the T1D Exchange Quality Improvement Collaborative (QIC) team at ISPAD 2021 below!

ISPAD 2021

Children and Adolescent patients with pre-existing type 1 diabetes and additional comorbidities have an increased risk of hospitalization from COVID-19; Data from the T1D Exchange COVID-19 Registry

This study’s aim is to determine if children and adolescents with T1D in addition to other pre-existing comorbidities were more likely to experience adverse outcomes than children and adolescents with T1D and COVID-19 who did not have any other comorbidities.

592 people with T1D below age 24 with COVID-19 were analyzed from the T1D Exchange COVID-19 Surveillance Registry. The results showed that people with T1D plus at least one other comorbidity had a higher rate of diabetes-related ketoacidosis (DKA) and a higher all-cause hospitalization rate compared to T1D children and adolescents without additional comorbidities.

Making diabetes EHR data actionable: T1D Exchange Quality Improvement portal (T1Dx-QI portal) an innovative tool for collaborative diabetes care improvement

This study aims to describe an innovative EHR-based web portal; a tool which supports the sharing of best practices and clinical innovations for improving outcomes in patients with diabetes across nine US-based pediatric endocrinology clinics in the T1D Exchange QIC.

Participating clinics securely share patient-level de-identified data that is then transmitted to the portal. QIC clinics can assess and benchmark their local EHR data with other clinics using the same improvement metric definitions.

From December 2019 through June 2021, there has been a sustained increase of 83% in portal engagement. All T1D Exchange QIC sites in the portal have demonstrated sustained improvement in at least two areas, with 50% of QIC sites sustaining improved results across four areas.

This analysis highlights that the T1Dx-QI Portal is a novel platform for collaboration using real-world EHR-based data to improve health outcomes among youths with diabetes.

Strong association between health insurance type and adverse outcomes for pediatric and adolescent patients with type 1 diabetes and COVID-19; Data from the T1D Exchange COVID-19 Registry

Health insurance coverage type differs significantly by socio-economic status and racial groups in the United States.

The goal of this study was to determine if publicly insured children and adolescents with T1D were more likely to experience adverse outcomes compared to privately insured patients with acute COVID-19 infections.

People with T1D and COVID-19 who were on public insurance reported higher A1cs, lower rates of insulin pump use, as well as lower rates of CGM use compared to privately insured people with T1D. Publicly insured children and adolescents with T1D and COVID-19 were also three times more likely to be hospitalized than those with private insurance.

Our data reveals this higher rate of hospitalization and DKA among children and adolescents with T1D and COVID-19 with public health insurance despite controlling for other potential factors.

Increase in newly diagnosed type 1 diabetes among pediatric and adolescent patients during the COVID-19 pandemic in the United States: A multi-center analysis

An increase in newly diagnosed T1D has been posited during the COVID-19 pandemic, but data have been conflicting.

We aimed to determine trends in newly diagnosed T1D and severity of presentation at diagnosis for children and adolescents during 2020, as compared to 2019 in a multi-center data analysis across the United States.

We found that of the newly diagnosed people with T1D, a greater number experienced DKA at diagnosis in 2020 compared to 2019, and a higher proportion of these patients presented with severe DKA.

Future longitudinal studies are needed to confirm these findings with population level data, and to determine the long-term impact of COVID-19 on diabetes trends.

“The Smart Insulin Pen”: A great tool for those who want the benefit of a pump but don’t want to wear an insulin pump! A Qualitative Study on Facilitators to Smart Insulin Pump Use

The purpose of this study was to identify factors that increase smart insulin pen use by assessing health care provider and care team perceptions of smart pens.

In this study, health care providers viewed smart insulin pens as an acceptable alternative to pump therapy, and as a tool to engage people with T1D in their own self-management and increase accountability for insulin administration.

Some providers gave testimonials about smart insulin pens, including the following: “Especially for the kids who didn’t want to go on a pump, that they can still have a lot [of benefits of dose calculator] without using a pump.” Other providers noted, “I’ve had a couple of teenagers really take ownership of their diabetes in sending in those reports” and “It can really help to structure the clinic visits and make them more productive.”

All respondents in this study saw smart insulin pens as a beneficial tool with benefits to the individual with T1D, their caregivers, providers, and the clinic.

Identifying and addressing barriers to smart insulin pen use: a T1D Exchange qualitative study of diabetes providers

Barriers to successful smart insulin pen use exist, and these barriers must be identified and addressed in order to be alleviated.

The purpose of this study was to identify the barriers and operational challenges to successful smart insulin pen use by assessing diabetes care team perceptions at participating pediatric clinics within the T1D Exchange QIC.

The highest impact barriers were cost, insurance coverage, the prescription process, sufficient training and education for both clinicians and people with T1D, technological difficulties, and language barriers. In addition, medium and low impact barriers included care team prescribing comfort level, smart phone access and functionality, and battery life of smart pens.

All participating clinics report that the benefits from smart insulin pens outweigh these barriers.

These findings highlight the need for increased provider and diabetes care team education and training on smart insulin pen features, use, and prescription process to support smart pen use in youth with T1D.

Factors associated with hospitalization in youths and young adults with type 1 diabetes and COVID-19

Numerous studies have investigated the impact and increased severity of COVID-19 in adults with T1D, however these findings cannot be generalized to affected children and young adults.

The de-identified COVID-19 patient dataset from the December 2020 release of Cerner Real-World Data contains longitudinal data for people who received care at 87 U.S.-based health systems between December 2019 and September 2020. Within this dataset, we identified a subset of people with T1D under age 27. This data was then used to examine race/ethnicity, gender, HbA1c, body mass index (BMI), mean blood glucose, age, payer, and Elixhauser comorbidity score (ECS) as correlates of hospital admission and DKA.

In this group of 224 youths and young adults with T1D, 65.6% of patients were hospitalized, and 37.1% of T1D patients were in DKA. The factors found to be associated with DKA included HbA1c and public insurance.

In patients who were not experiencing DKA, hospitalization was associated with a higher ECS.

Factors associated with hospitalization in youth and young adults with type 2 diabetes and COVID-19

Similar to the above study, we examined the factors associated with hospitalization in children and young adults with type 2 diabetes (T2D) and COVID-19 infection.

In this cohort of 229 people under age 27 with T2D and COVID-19, 89.1% were 18-26 years old, and 58.1% were female. 41% of people in this group were hospitalized, including 21 people who were experiencing DKA.

Male gender, increased HbA1c, and increased BMI are associated with hospitalization in youths and young adults with T2D and COVID-19 infection. Further study is needed to identify targeted interventions to prevent hospitalization in children and young adults with T2D.

Diabetic ketoacidosis rates rose among patients with type 1 diabetes during U.S. COVID-19 peaks with highest burden on non-Hispanic Blacks

With this study, we examined the U.S. trends in DKA rates across the lifespan during the COVID-19 pandemic and factors associated with these trends, compared to DKA rates the year before the pandemic.

The T1D Exchange QIC collected data on the incidence of DKA among children and adults with T1D from 7 large medical centers in the U.S. We compared DKA rates during COVID-19 Wave 1 (March-May 2020) and COVID-19 Wave 2 (August-October 2020) to the same periods in 2019.

DKA rates were higher in people with T1D during both COVID-19 Wave 1 and COVID-19 Wave 2 compared to the same periods in 2019. There were no differences in rates of DKA by age or DKA severity.

Consistent with known T1D inequities, DKA rates in 2020 were exacerbated for non-Hispanic Black people with T1D with 18% of that population experiencing DKA, compared to 6% of non-Hispanic White people with T1D.