Empowering People with Diabetes in the LGBTQ+ Community with Inclusive Care - T1D Exchange

Research from the T1D Exchange Quality Improvement Collaborative (T1DX-QI) emphasizes the crucial need to examine how healthcare systems cater to the needs of different individuals.  

The study, “LGBTQ+ Supportive and Inclusive Care Practices in the T1D Exchange Quality Improvement Collaborative” was presented at the American Diabetes Association’s 83rd Scientific Sessions in San Diego, CA, on June 23, 2023. 

Authors of this study include: Ann Mungmode, Jesse Cases-Villablanca, Jaquelin J. Flores Garcia, Ashley Butler, Carla Demeterco-Berggren, Nicole Rioles, Margarita Ochoa-Maya, Makaila Manukyan, David M. Maahs, Ryan McDonough, and Shideh Majidi.

Conducting LGBTQ+ research in the T1DX-QI 

The T1DX-QI includes 54 participating endocrinology centers across the country, treating over 85,000 people with type 1 diabetes (T1D) — and 20,000+ with type 2 diabetes (T2D) through a new pilot program. 

When it comes to diabetes care, individuals with gender-expansive identities and diverse sexual orientations often face unique challenges and disparities compared to their non-LGBTQ+ peers. Simply acknowledging a person’s preferred gender in conversations and in their patient records, for example, can play a significant role in their overall well-being and relationship with their healthcare team. 

The T1DX-QI set out to identify and improve the quality of inclusive healthcare provided to people with diabetes in the LGBTQ+ community. 

Study results: are patients receiving inclusive care? 

This research involved 33 pediatric and 17 adult T1DX-QI centers, providing care to patients of all ages. The following insights were gathered on the extent of LGBTQ+ inclusive practices within diabetes care:  

• Gender-Affirming Care: A promising discovery emerged, with the majority of pediatric (88%) and adult (76%) centers reporting that gender-affirming care was legally supported in their respective states. This acknowledgment of the importance of affirming gender identity is a significant step towards ensuring comprehensive care for the LGBTQ+ community. 
• Gender Identity Documentation: Nearly 90% of all participating pediatric and adult centers documented patients’ self-identified gender identity. By recognizing and respecting individuals’ gender identities, healthcare providers can create an environment that fosters trust and promotes better health outcomes. 

• Pronoun Documentation: Pediatric centers (82%) surpassed adult centers (65%) in actively documenting the pronouns used by patients with diabetes. By embracing the use of correct pronouns, healthcare providers demonstrate respect and validate individuals’ gender identities. 
• Sex Assigned at Birth (SAAB) Documentation: The majority of pediatric (97%) and adult (82%) centers included SAAB in their patient records, a crucial aspect of medical history. By acknowledging SAAB, healthcare providers can better tailor their care and treatment plans to individual needs. 
• SAAB Update in Health Records: Less than half of the institutions (39% pediatric and 24% adult) had mechanisms in place to update SAAB within their electronic health records. This highlights an area that requires attention and improvement to ensure accurate and up-to-date patient information. 
• Sexual Orientation Documentation: Only 44% of pediatric and 47% of adult centers documented sexual orientation, revealing a significant gap in capturing this aspect of patient identity. To provide truly comprehensive care, it is essential to consider sexual orientation as an integral part of a patient’s overall well-being. 
• Strategies for Gender Identity and Sexual Orientation: 64% of pediatric and 53% of adult centers have implemented strategies to support discussions about gender identity and sexual orientation within their clinics. These proactive measures indicate a growing recognition of the importance of inclusivity and sensitivity in healthcare settings. 

The results are truly encouraging — but there is significant room for improvement. While many T1DX-QI centers have taken steps to document gender identity and pronouns, there is more to be done, particularly regarding the documentation of sexual orientation.  

By expanding efforts to capture this information and implementing inclusive care practices, healthcare providers can better support and empower the LGBTQ+ community living with diabetes. Further research is needed to fully understand how implementing supportive and inclusive care practices impacts health outcomes for LGBTQ+ patients with diabetes. 

By embracing inclusivity, healthcare providers can break down barriers, provide compassionate care, and create an environment where all patients — regardless of their gender identity or sexual orientation — feel respected, valued, and truly seen.