With nearly 2 million people across the country living with type 1 diabetes (T1D) and thousands of endocrinology clinics, collaboration may seem obvious. And yet, it’s quite rare. The T1D Exchange Quality Improvement Collaborative (T1DX-QI) is working to change this. 

In a disease as complex as T1D — with rapidly changing tools and medications available to manage it — the potential benefits of working collaboratively are limitless — particularly for those living with T1D.  

Here’s a look at the impact of the T1DX-QI’s extensive collaborative work striving to improve care and quality of life for people with T1D. 

Quality Improvement vs. Traditional Research  

Established in 2016, the T1DX-QI began with just 10 well-established, predominantly pediatric, academic diabetes pilot centers. Today, over 50 clinics participate in this collaborative effort to improve care for youth and adults with T1D.  

The successes of the T1DX-QI thus far highlight the immense value and importance of learning health systems, data-sharing, benchmarking, and peer collaboration.  

The differences between “quality improvement” and traditional “research” are significant. A few comparison examples include: 

  Quality Improvement  Research 
Purpose  Systematic approach to examine processes to improve patient outcomes, care, and clinic workflow  A scientific study to generate new evidence and knowledge for the medical community 
Question  What changes can we make to improve the process?  What is the standard of care? 
Effect on program being studied  Expectation that findings will directly affect the program  No expectation that findings will directly affect the program 
Timing  Rapid tests  Longer review/evidence generation 
Risks  Does not place participants at risk  May place participants at risk 
Benefits  Directly benefits a process, program or system; may or may not benefit participants  Participants may or may not directly benefit; benefit is often delayed to future knowledge 
Example  A QI project that aims to increase the percentage of patients using a continuous glucose monitor (CGM) from 35 to 60% over 4 months  A research study that aims to determine the effectiveness of a novel CGM device compared with older models 

 When a new center joins the T1DX-QI, they provide extensive detail about the demographics and clinical characteristics of their patient population. Each participating center develops its own QI projects or adopts change packages shared by other clinics in the T1DX-QI. 

Each center participates in monthly calls with an experienced QI coach provided to the clinic by T1DX-QI. Monthly webinars and an annual multi-day learning session provide the opportunity to network and share clinic insights. 

The results of this intensive collaborative effort include real-life changes in how clinics and providers support and care for people with T1D. Learn more about the T1DX-QI. 

Collaborative Research Identifies Barriers to Smart Insulin Pen Use 

Using a smart insulin pen (SIP) can potentially improve a person with T1D’s health significantly by ensuring they take insulin when needed, improving overall blood glucose management, increasing their time-in-range, and improving the accuracy of their insulin doses for meals and corrections.   

But many people with T1D who manage via multiple daily injections still don’t use a SIP. 

Through collaborative research in the T1DX-QI, providers were able to identify the most significant barriers to using a SIP. 

Identified barriers include: 

  • Insurance coverage & high copay costs: “I think there was one time we tried to get someone set up in the clinic. And I think the cash price is $35, and I know for some people, they can’t even afford that.” 
  • Prescribing process: “Providers need to be shown and need to be walked through how this works, all the data that [are] available on it. And I think more providers would be willing to prescribe it because then they know what they’re prescribing.” 
  • Team educator for training: “I was not really that comfortable with even suggesting it for the longest time, because I didn’t really know how to tell the families how it worked.” 
  • Smartphone access: SIPs require relatively up-to-date smartphone technology to display, generate, and review data. 

“I think there [are] a lot of patients who wanted the benefit of a pump but didn’t want to wear a pump,” explains a provider in the study. “And, I mean, obviously, you don’t have a basal rate, but you still get a lot of the benefits of pump calculation. And I think a lot of parents like that. And, especially for the kids who didn’t want to go on a pump, they can still have a lot of that without using a pump.” 

Overall, 63% of clinics in the study reported minor or major improvements in health outcomes after prescribing SIPs to their patients. Clinic respondents said they would like to increase SIP prescribing within their practice.  

Through QI, the barriers and use of SIPs could be efficiently studied with the ultimate result of increasing a clinic’s awareness and education of this technology. 

Collaborative Healthcare = The Potential to Better Support Patients 

The real-world changes that can result from collaborative work across multiple endocrinology clinics are greater than we can convey in one study. Just as getting through the day with T1D comes down to dozens of micro-decisions, so does support and caring for people with T1D in a clinical setting.  

The T1DX-QI creates the ultimate environment for providers to identify and improve any area of patient care.