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PRACTICAL STRATEGIES TO INCREASE CONTINUOUS GLUCOSE MONITOR (CGM) USE FOR UNDERSERVED PATIENTS WITH T1D IN THE US: RESULTS FROM THE T1D EXCHANGE MULTICENTER EQUITY STUDY
O. Odugbesan1, A. Mungmode1, N. Rioles1, D. Buckingham2, G. Nelson3, S. Agarwal4, A. Grant5, E. Hess6, O. Ebekozien1
Background and Aims: Studies have demonstrated lower use of CGM in Non‐Hispanic Black (NHB) and Hispanic patients compared to Non‐Hispanic White (NHW) patients with type 1 diabetes (T1D) in the United States. This study describes practical solutions from the T1D Exchange Quality Improvement Collaborative (T1DX‐QI) to increase CGM use and reduce disparities.
Methods: T1DX‐QI recruited 2 adult and 3 pediatric endocrinology centers serving 13,000+ patients with a mean (SD) age of 25.9 (15.6). Aggregate baseline data were stratified by race and ethnicity between November 2020 and June 2021. Centers met monthly to identify contributors and brainstorm and prioritize interventions from June to July 2021. Centers used rapid Plan‐Do‐Study‐Act improvement cycles to test interventions from July 2021 to September 2022. Successful interventions such as provider bias training, translation of CGM materials, CGM education in other languages, SDOH screening, and shared decision‐making were expanded and sustained. Data was reported monthly to the coordinating center and plotted on a trend chart. Statistical analysis testing for significance between pre and post‐interventions was conducted using McNemar’s test.
Results: Pre‐intervention median CGM use was 69% among NHW patients, 51% among NHB patients, and 56% among Hispanic patients. The median increased by 7% in NHW, 12% in NHB, and 15% in Hispanic patients. The gap between NHW and NHB was reduced by 5% and the gap between NHW and Hispanic patients were reduced by 6%. The trend was significant with a P value <0.05 for both groups.
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