The 16th international ATTD (Advanced Technology and Treatments for Diabetes) conference was held in Berlin, Germany on February 22-25th. Despite the many advancements in today’s diabetes technology and treatments, too many people across the globe still don’t have access to these life-changing and life-saving options. Improving health equity in diabetes care is a must. 

T1D Exchange presented research from our Quality Improvement Collaborative (T1DX-QI) with insights on the real-life impact when a person with type 1 diabetes (T1D) has proper access to modern technology.  

This research was presented by leaders within our T1DX-QI team:  

The T1DX-QI is comprised of 54 participating endocrinology clinics in 22 states across the country, caring for approximately 85,000 people with T1D and 20,000 with T2D.

Published research presented at ATTD 2023 in Berlin 

With a focus on health equity and access to today’s standard of care technology, the T1DX-QI presented research on the following published research: 

Here’s a deeper look at three of these published studies:  

Increasing CGM use in underserved patients 

Introduction: The life-saving benefits of using a continuous glucose monitor (CGM) in in T1D management are clear, but the proportion of people of color who use this tech is significantly lower compared to white people with T1D.  

Objective: This study proposed practical solutions for increasing CGM use in Non-Hispanic Black (NHB) and Hispanic populations. These proposed solutions were applied in two adult and three pediatric endocrinology clinics within the T1DX-QI, serving approximately 13,000 people with T1D. The average participant age was 25 years old. 

Practical solutions included: identifying provider bias, training to change provider bias, translating CGM materials/education to other languages, screen for social determinants of health (SDOH) to address housing/food insecurities, etc., and ensuring that doctors are making decisions with input from each patient. 

CGM use based on race/ethnicity before the study: 

  • 69% of Non-Hispanic White (NHW) participants 
  • 51% of Non-Hispanic Black (BHB) participants 
  • 56% of Hispanic participants 

CGM use based on race/ethnicity after applying practical solutions: 

  • 78% of Non-Hispanic White (NHW) participants 
  • 64% of Non-Hispanic Black (BHB) participants 
  • 71% of Hispanic participants 

Conclusion: This research demonstrates the critical impact of addressing SDOH obstacles like housing and food insecurity, a doctor’s implicit bias towards technology use in certain race/ethnicities, and the lack of educational materials in different languages. 

Reducing DKA with closed-loop pumps 

Introduction: By automating insulin delivery, closed-loop pumps offer the potential to decrease the frequency of diabetic ketoacidosis (DKA) in people with T1D. DKA is a life-threatening complication that today’s technology holds the potential to reduce and prevent. 

Objective: This study analyzed the impact of closed-loop pump technology on the frequency of DKA using the T1DX-QI’s electronic medical records database of approximately 60,000 people with T1D. The data was broken down to evaluate based on age, gender, race/ethnicity, insurance status, and total daily insulin use. 

Results on self-reported DKA frequency based on insulin-delivery method: 

  • Closed-loop pump: 178 events in 1,537 people 
  • Pump with CGM: 365 events in 3,067 people 
  • Pump without CGM: 739 events in 5,623 people 
  • MDI with CGM: 51 events in 257 people 

Conclusion: Based on this real-world data, closed-loop pumps are associated with a decreased likelihood of DKA. Improving access to this technology is a potentially effective method of preventing DKA hospitalizations in people with T1D. 

Reducing severe hypoglycemia with closed-loop pumps 

Introduction: By automating insulin delivery, closed-loop insulin pumps offer the potential to decrease the frequency of severe hypoglycemia in people with T1D. Severe hypoglycemia is a significantly traumatic and burdensome experience for those on daily insulin therapy. The day-to-day management of T1D carries with it an ongoing stress over preventing severe hypoglycemia, also known as “fear of hypoglycemia,” that can lead a person to purposefully run higher blood glucose levels. 

Objective: This study analyzed the impact of closed-loop pump technology on the frequency of severe hypoglycemia using the T1DX-QI’s electronic medical records database from 20 participating endocrinology clinics.  

Results on self-reported DKA frequency based on insulin-delivery method: 

  • Closed-loop pump: 26 events in 1,537 people 
  • Pump with CGM: 214 events in 3,067 people 
  • Pump without CGM: 450 events in 5,623 people 
  • MDI with CGM: 352 events in 1,533 people 

Conclusion: Based on this real-world data, using closed-loop pumps to manage insulin delivery in people with T1D is associated with a decreased frequency of self-reported severe hypoglycemia. 

Learn more about our health equity research here!