For Daniel DeSalvo, MD, caring for children with T1D means helping them see that diabetes is just one part of who they are — not something that defines them or limits what they can do.
“Diabetes is a really challenging condition to live with, especially in young children who don’t want to stand out and be different from their peers,” said DeSalvo, a pediatric endocrinologist at Baylor College of Medicine/Texas Children's Hospital.
That understanding is central to his approach. A practice informed by compassion, a belief in teamwork, and a dedication to system-wide quality improvement to promote equity and access for all youth in its care.
As Texas Children's Director of Strategic Collaboratives and Outpatient Quality Improvement for the past decade, DeSalvo, who lives with T1D himself, said he always keeps in mind two sides of being a young person with diabetes.
“One side is how challenging it is to live with diabetes,” DeSalvo said, "with the finger sticks and injections, wearing a CGM and pump, and having to count your carbs and remember to bolus. There can be bumps along the way.”
And the other side, DeSalvo said, “is that these youth with diabetes are incredible. They’re intelligent. They're beautiful. They're creative. They're athletic. Diabetes doesn't define them. It's one trait of who they are.”
Desalvo’s commitment to improving systems extends beyond Texas Children’s. As a principal investigator for the T1D Exchange Quality Improvement Collaborative (T1DX-QI), a national network of more than 60 centers caring for over 100,000 people living with type 1 diabetes, he credits the Collaborative for helping shape his approach to diabetes care as a team enterprise.
DeSalvo was recently awarded the 2026 Baylor College of Medicine Quality Improvement and Patient Safety (QIPS) Scholar Award, which recognizes faculty members committed to research that advances quality improvement and patient safety.
Much of DeSalvo’s work focuses on addressing persistent systemic barriers in diabetes care for children, such as access to technology, optimizing A1C levels and time in range, and reducing the risk of diabetic ketoacidosis (DKA).
Texas Children’s operates six diabetes clinics across the Houston area in addition to a standalone hospital in Austin, making it one of the largest pediatric medical systems in the country.
His goal, DeSalvo said, is to build “reliable proactive care models” that reduce preventable safety events, like DKA, improve glycemic outcomes, and help young people with diabetes thrive. “And that,” he said, “takes a lot of coordination.”
For instance, DeSalvo explained, his team develops SMART aims, which are specific, measurable, achievable goals, and implements PDSA (Plan-Do-Study-Act) cycles to test and refine how to achieve them.
Using predictive analytics, they can also help identify young people in the system with elevated risk. “All of that taken together has helped improve the outcomes and the lives of the youth that we care for — and we’re so passionate about,” DeSalvo said.
Texas Children’s has adopted a multi-pronged strategy to improve access to diabetes care and technology. Efforts include advocating for Medicaid coverage of continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems, expanding family education, and standardizing operations across facilities. The hospital has also invested in provider training and is working to address social inequities that can limit access to technology.
Over the past six years, CGM use among youth has increased dramatically — from about 20% to 90%, DeSalvo said. At the same time, the use of AID systems grew from about 6% to nearly 67%. “I’m really proud of these gains– it reflects the hard work and dedication of our multidisciplinary quality improvement team,” he said.
Those gains have corresponded with meaningful improvements in glycemic outcomes. Over the past four years, the average A1C at Texas Children’s has fallen from 8.6% to 8.2%, while the proportion achieving the recommended A1C target of less than 7% has increased from roughly 15% to 25%.
“So, while we’re seeing improvements, there’s still a lot of work to be done,” DeSalvo said. “We’re not nearly at the level that we hope to be.”
Texas Children’s also operates a wraparound support program called REACH Cohort to identify youth at higher risk for DKA and other adverse outcomes. The program brings together physicians, diabetes educators, psychologists, social workers, and community health workers to help families overcome barriers to care, including transportation, education, and access to technology.
Although DeSalvo has dedicated his career to caring for children with T1D, he wasn’t diagnosed with T1D until his sophomore year of college. At the time, he was studying political science with plans to attend law school.
He had always wanted to work with children and envisioned a career advocating for children and families through the legal system. His diagnosis changed that path.
“After about a year of living with type 1 and learning how to care for myself — and studying research in the field — I had this epiphany,” he said, “where I realized I really want to be a doctor for kids with diabetes.”
DeSalvo enrolled in pre-med classes the following year. “And I couldn’t be happier or more fulfilled,” he said, noting that his medical practice “really is a calling, to help improve the lives of people with T1D.”
DeSalvo also described how T1DX-QI has helped shape his understanding of diabetes care and created opportunities for scholarly growth. Through this type of collaborative work, DeSalvo has contributed to more than 80 T1D-related manuscripts.
“As someone who started as a junior faculty member in the T1D Exchange,” he said, “it was a great incubator for my career.”
DeSalvo is charting a direction that shifts “the paradigm of care from reactive to proactive” to help lessen the burden of T1D.
Broadening technology use is a big part of that: “In this new era where we have cloud-connected devices,” he said, “you can get data signals and leverage predictive analytics to understand, in near real time, who’s at risk for suboptimal glycemic outcomes or acute safety events like DKA.”
Emerging tools — including continuous ketone monitors, inhaled insulin, and expanded early-stage T1D screening through the Sit Down T1D! program at Texas Children’s — is transforming diabetes care. Moreover, disease-modifying therapies, such as teplizumab (Tzield), are key developments that address the underlying autoimmune process and may delay the onset of Stage 3 T1D and slow the decline in insulin production in those recently diagnosed with T1D (ages 8-17).
“It’s not just the technology,” he said. “It’s having relationship-based care and education to improve clinical outcomes while optimizing quality of life and reducing burden.”
Despite the challenges, DeSalvo said the resilience of young patients continues to inspire him. “Nothing brings me greater joy than to see them thriving, not just with their diabetes, but with whatever their goals are in life,” he said. “When you have T1D, there are no limits. Whatever your goals are, you can achieve them and have an impact.”