Many studies have demonstrated the clinical benefit of continuous glucose monitoring (CGM) in type 1 diabetes (T1D). Although favorable insurance policy changes have gradually increased the access of CGM nationally, widespread uptake has been slow. The T1DX-QI is a national type 1 diabetes learning collaborative coordinated by the T1D Exchange in Boston, MA.

This work describes how 10 diabetes centers in the T1DX-QI used QI principles including the Plan – Do – Study – Act (PDSA) cycles to test and expand different interventions to increase CGM use in their respective centers. Successful efforts include the redesign of relevant workflows, assessing and removing barriers to adoption, developing CGM patient education classes, and advocating for state Medicaid coverage of CGM. The centers piloted these changes in 12 – 26 year olds with T1D.

The coordinating center used statistical process control charts to evaluate the effectiveness of the interventions (Figure 1). Eight of 10 participating centers improved CGM use significantly. There was a 12% improvement from over 20 months across the entire cohort of centers (range 7-34%).

This demonstrates that by using QI principles to test interventions and cross-learning, the T1D community can increase use of CGM devices.

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