How T1D Exchange is Improving Care for People with Type 1 Diabetes - T1D Exchange

While you’re probably familiar with diabetes research related to getting new types of insulin or medications approved, you may not be familiar with the unique approach to research that T1D Exchange has been developing over the last eight years. Our variety of research methods is directly improving the lives of people with type 1 diabetes (T1D).

Here’s a glance at some of the work we’ve been developing since 2016 that strives to improve your daily quality of life and the care you receive at your healthcare provider’s office as a person with type 1 diabetes.

The T1D Exchange Quality Improvement Collaborative (T1DX-QI)

The T1DX-QI was launched in 2016 with support from the Leona M. and Harry B. Helmsley Charitable Trust. Today, the T1DX-QI has 50 participating endocrinology clinics from across the U.S.—and this number continues to grow each year.

Through these participating clinics, we are able to identify critical issues in patient care and develop potential solutions that can then be tested and analyzed.

Examples of past and current studies include:

• COVID-19 Surveillance Project: This project was a multi-center study with monthly data collection of critical variables over 15 months, assessing outcomes and racial-ethnic health disparities in people with T1D with COVID-19. Results revealed adverse outcomes that included DKA, severe hypoglycemia, and hospitalization.
• DKA and New-Onset Trends Project: This project analyzed electronic medical records and other data to compare DKA and new-onset trends in people with T1D during the COVID-19 pandemic. Eight clinics submitted data for this analysis, and findings demonstrated that compared to 2019, in 2020, there was an increase in newly diagnosed T1D. There was also a greater proportion presenting in DKA at diagnosis during the COVID-19 pandemic.
• Fear of Hypoglycemia Screening Project: Goals of this ongoing project include analyzing what resources and clinical processes a clinic and healthcare provider would need to adequately screen for fear of hypoglycemia (FOH). It also seeks to determine the prevalence of FOH among adults with T1D and implement routine screening to identify FOH.
• Telemedicine Project: This ongoing project is analyzing changes in telemedicine trends during the COVID-19 pandemic in a 1-year follow up to a 2020-2021 paper. The project team collected data on 13 T1DX-QI clinics for current telemedicine practices and surveyed 33 clinics for barriers and perceptions of the existing clinic telemedicine state.
• Smart Pen Qualitative Study: This study examined the barriers, perspectives, and operational challenges a provider may encounter in prescribing smart insulin pens. Results revealed that the provider’s effort to prescribe this type of insulin pen outweighed the reported barriers (cost of copay, insurance coverage, overall prescribing process).
• Real-World Continuous Glucose Monitor (CGM) Analysis: The goal of this ongoing project is to analyze outcomes for people with T1D using real-time continuous glucose monitoring (rtCGM) products in comparison to those not using rtCGM. This project will use the T1DX-QI electronic medical record database to analyze outcomes.
• Diabetes Device Equity QI Pilot: This project is part of the T1DX-QI Health Equity Advisory Lab (HEAL) developed to address the dangerously pervasive health inequities amongst racial and ethnic groups in both pediatric and adult T1D care. It works to evaluate the effectiveness of a provider’s unconscious bias training as an intervention to address systemic inequality in T1D care management. Seven T1DX-QI clinics are using the T1DX-QI Equity Framework to test changes in clinical practice that support more equitable CGM and insulin pump prescription.

Successful research can also lead to “Change Packets”

When a study pinpoints potential solutions to improve patient care and health-related outcomes, guidelines for implementing that solution in other endocrinology clinics are then organized into a Change Packet.

A Change Packet can then be adopted by endocrinology clinics across the country, improving patient care clinic by clinic.

Examples of our published Change Packets include:

Intervention method to help people with A1cs above 9%
Patients designated as “high-risk” are those with an HbA1c value above 9% between the ages of 12 and 26 years old. This group of people faces a higher risk of experiencing diabetes-related ketoacidosis (DKA)—which can lead to hospitalization, coma, and death. They have a significantly higher risk of diabetes-related complications associated with chronically high blood glucose levels.

Ten clinics in the T1DX-QI used an adaptation of an existing healthcare improvement model to address this high-risk patient population. It includes test ideas employed by the different participating sites and is shaped by their experiences. The Change Packet aims to provide a robust framework of interventions to help high-risk people with T1D in a variety of clinical settings improve their day-to-day glycemic health.

Participating clinics using these intervention methods were found to help people reduce HbA1c significantly and remove themselves from the high-risk category altogether. For example, a study at Baylor University found that patients were improving HbA1c levels from 14% to 8.5%, and 11% to 7.4%.

Improved screening process for early signs of depression
Depression is a contributing factor to suboptimal health outcomes and is common among adolescents and adults with chronic health conditions, such as diabetes. When present, depression in adolescents with type 1 diabetes is associated with less frequent blood glucose monitoring, higher A1c values, and increased rates of diabetes-related hospitalizations.

Given the impact of depression on a person’s ability to manage the daily work of diabetes, early and annual screening for signs and symptoms of depression is critical. The age (teenager versus adult) of the people being screened also plays a critical role in the design of that screening process.

This change packet offers extensive new guidelines for screening, scoring, and intervening in patients struggling with depression, ensuring that fewer people “slip through the cracks” in the mental health screening process referred to as the “Depression Screening Tool Kit.”

This is just a glance at our work!

Our work within the T1DX-QI is one branch of what we do. Stay tuned for another deep glance at the work we’re doing to improve the lives of people with type 1 diabetes through our Online Community and the T1D Exchange Registry. Sign up to stay in the loop by clicking the “Join” button in the top right corner of your screen!