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Every year the Advanced Technologies & Treatments for Diabetes (ATTD) conference brings together diabetes researchers from all over the world. This week, the conference is in-person in Barcelona for the first time since 2020.
The T1D Exchange team is honored to deliver five oral presentations and five poster presentations at this year’s conference. We are proud to present studies from the Quality Improvement Collaborative (T1DX-QI), and the T1D Exchange Registry and Outcomes Research. Check out the highlights of these studies below!
Comparative Efficacy of Intermittently Scanning CGM, Real-Time CGM, and Self-Monitored Blood Glucose among Patients with Type 1 Diabetes: Real-World Evidence from a Multi-Center Study
This real-world study using Electronic Medical Record (EMR) data from the T1DX-QI demonstrates the potential health benefits of using a real-time CGM compared to both intermittently scanning CGM and self-monitored blood glucose using a meter.
- Real-time CGM users had the lowest self-reported A1cs, severe hypoglycemic events and diabetes-related ketoacidosis events compared to patients using intermittently scanning CGMs or self-monitored blood glucose.
- Those who used real-time CGMs spent more time in range and less time below 70 mg/dL than those who used intermittently scanning CGMs.
Full study abstract listed under number OP021 / #143 at this link: https://www.liebertpub.com/doi/10.1089/dia.2022.2525.abstracts
Patient Perspectives on Factors Affecting CGM Accuracy, Utility and Decision Making in People with Diabetes within the T1D Exchange Community
This survey aimed to understand the opinions and experiences of CGM users, and identify the reasons that cause people to stop using a CGM.
- CGM use: 49% of survey respondents had previously temporarily stopped using CGM, of whom 59% stopped for at least one month.
- Accuracy: Despite 90% stating that the majority of sensors were accurate, 42% thought accuracy varied from sensor to sensor. 15% of respondents stated that less than 6 out of 10 sensors are accurate.
- Confidence: About 25% agreed that poor sensors often affected their confidence dosing insulin or ability to make T1D management decisions.
- Concerns: 35% were concerned about the effects of over-the-counter or prescription medications on sensor accuracy.
- The top 5 reasons for stopping CGM use were:
1. Inaccurate readings
2. Sensor falls off before sensor end time
3. Skin irritation
4. Too many alarms
5. Too many false alarms
Full study abstract listed under number EP158 / #83 at this link: https://www.liebertpub.com/doi/10.1089/dia.2022.2525.abstracts
Hybrid Closed Loop Systems and Glycemic Outcomes in Children and Adults with Type 1 Diabetes: Real World Evidence From U.S. Based Multi-Center Collaborative
This study using T1DX-QI EMR data compared glycemic outcomes in people with T1D using hybrid closed loop systems (e.g., Tandem t:slim X2 with Control-IQ or Medtronic 670G or 770G pump with automated mode), versus people using insulin pumps and CGMs without automated insulin delivery, and people using multiple daily insulin injections (MDI) with CGMs.
- Using a hybrid closed loop system was associated with lower A1c levels and higher time in range.
- The use of advanced diabetes technology was lower for non-Hispanic Black people and people on public insurance, indicating that social disparities continue to be a hindrance to better health outcomes in these groups.
Full study abstract listed under number OP049 / #141 at this link: https://www.liebertpub.com/doi/10.1089/dia.2022.2525.abstracts
Inequities in Diabetes Device Use: Update from T1D Exchange Health Equity Project
The T1D Exchange Quality Improvement Collaborative (T1DX-QI) identified six endocrinology centers to pilot an equity-focused study to address disparities in CGM use amongst Non-Hispanic Black (NHB) and Hispanic people with T1D compared to Non-Hispanic White (NHW) people.
- Before the pilot in June 2021, the median CGM use was: 59% in NHW patients, 44% in NHB patients, and 43% in Hispanic patients.
- During the pilot in January 2022, the median CGM use was increasing across all groups: 71% in NHW patients, 52% in NHB patients, and 58% in Hispanic patients.
- The disparity gap between NHW and NHB shows a stable trend, but the gap between NHW and Hispanic shows a 3% improvement.
The T1DX-QI developed a QI Equity Framework and will continue to use the framework to develop and scale interventions that address disparities for Non-Hispanic Black and Hispanic people with T1D. This project is funded by Medtronic Diabetes.
Full study abstract listed under number OP022 / #227 at this link: https://www.liebertpub.com/doi/10.1089/dia.2022.2525.abstracts
Diabetes Provider Bias to Recommending Diabetes Technology for Patients on Public Insurance in the United States
In this study, providers ranked patients’ factors in the order of consideration for initiating CGM and insulin pump therapy (1 = most important to 7 = least important). The factors ranked were race/ethnicity, the family’s income, age, A1c, type of insurance coverage, self-monitoring blood glucose (SMBG), and patient/family preference. This project is funded by Medtronic Diabetes.
- Implicit bias against public insurance was common in our cohort at 61% of providers.
- Providers with insurance-mediated bias were older.
- Providers who did not have bias had fewer practice years compared to those who had bias.
- For pediatric providers, insurance was ranked as the 3rd and 4th most important factor for prescribing CGM and insulin pump, respectively.
- For adult providers, insurance was ranked as the 2nd and 3rd most important factor for prescribing CGM and insulin pump, respectively.
Full study abstract listed under number OP063 / #188 at this link: https://www.liebertpub.com/doi/10.1089/dia.2022.2525.abstracts
Race-ethnicity Mediated Bias in Recommending Technology: Does Implicit Bias Training Make a Difference?
For this study, we investigated factors associated with implicit bias to recommending diabetes devices based on race/ethnicity among pediatric and adult endocrinologists. This project is funded by Medtronic Diabetes.
- Racial-ethnic mediated implicit bias was present in approximately 34% of our cohort.
- The presence of racial-ethnic mediated implicit bias did not differ by age, provider role, or provider type.
- Providers who agreed with the statement “I am able to recognize my own bias”, measuring explicit bias, had more bias than those who did not.
Our work adds to the existing literature that training on anti-racism alone doesn’t sufficiently improve implicit racial-ethnic bias. We demonstrate that the providers’ ability to recognize their explicit bias was not protective against implicit racial-ethnic bias.
Full study abstract listed under number EP294 / #172 at this link: https://www.liebertpub.com/doi/10.1089/dia.2022.2525.abstracts
Ranking Of Important Factors in Recommending Diabetes Technology by Pediatric and Adult Endocrinologists
As part of the T1D Exchange Health Equity Advancement Lab (HEAL) Study, we aimed to understand the preference of providers in prescribing diabetes technologies.
Providers ranked the following factors from most important to least important: insurance, race, income, patient technology preference, A1c, age, and self-management of blood glucose (SMBG).
- When deciding to recommend insulin pump therapy, providers ranked the top three most important factors:
1: Patient technology preference
2: SMBG practice
- When deciding to recommend CGM, providers ranked the top three most important factors:
1: patient technology preference
2: SMBG practice
3: Patients’ insurance type
- Race/ethnicity was consistently ranked by providers to be the least important consideration. However, insurance-mediated bias directly and disproportionately impacts people of color.
Full study abstract listed under number EP293 / #171 at this link: https://www.liebertpub.com/doi/10.1089/dia.2022.2525.abstracts
The Association between Body Mass Index (BMI) and Time in Range among Young Adults with Type 1 Diabetes: Data from the T1D Exchange QI Collaborative
Obesity in T1D is known to be associated with higher blood glucose levels and diabetes-related complications. The primary objective of this study was to determine if body mass index (BMI) is associated with time in range.
- In this analysis of young adults with T1D, we found that the following groups were more likely to have a lower average time in range:
– People with a BMI of 25 or higher
– Publicly insured people
– People of Hispanic race/ethnicity
Full study abstract listed under number EP107 / #145 at this link: https://www.liebertpub.com/doi/10.1089/dia.2022.2525.abstracts
Experiences of Caregivers of Children and Young Adults with Type 1 Diabetes Related to Severe Hypoglycemia and Being Prepared with Nasal Glucagon – A Qualitative Study
This qualitative study, which was presented at ADCES 2021, aimed to understand caregiver experiences – including psychological distress, well-being, and social function – regarding their child’s risk for severe hypoglycemia and preparedness to handle severe low blood glucose events.
- We saw a theme of vigilant efforts to prevent severe low blood glucose levels.
- Participants described the diabetes “daily grind” and how much of their day and night was dedicated to their child’s diabetes management.
- More than half of participants stated that they experienced interrupted sleep due to preventing and treating lows, as well as worrying about the possibility of low blood glucose levels.
- Caring for their child’s diabetes and preventing severe hypoglycemia impacted other areas of their lives, often causing strain on social relationships, social inhibition, and impeding their work lives.
- Caregiver’s perceived nasal glucagon as easier to use than injectable glucagon requiring reconstitution and discussed increased confidence in their own and other people’s abilities to treat severe hypoglycemia.
Full study abstract listed under number EP290 / #134 at this link: https://www.liebertpub.com/doi/10.1089/dia.2022.2525.abstracts
Validation of Fear of Hypoglycemia Screener: Results from the T1D Exchange Registry
Another encore presentation from ADCES 2021, this study examined the reliability and validity of a newly developed fear of hypoglycemia screener for use in clinics for adults with T1D.
- The new screener is a valid and reliable tool for detecting fear of hypoglycemia in adults with T1D.
- This screener will continue to be assessed in diabetes clinics to help identify those in need and to facilitate conversations between healthcare providers and people with T1D about this topic.
Full study abstract listed under number OP014 / #379 at this link: https://www.liebertpub.com/doi/10.1089/dia.2022.2525.abstracts
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ATTD: CGMs, Automated Insulin Delivery, and Provider Biases
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