In the July 2021 edition of Clinical Diabetes, T1D Exchange is featured in a special collection of articles about the T1D Exchange Quality Improvement Collaborative (QIC).

Clinical Diabetes is a publication that informs health care providers involved with caring for people with diabetes on advances and state-of-the-art care for people with diabetes. This aligns closely with the QIC’s work to create a collaborative space for health care providers to share information and strategize about how to improve treatment and care for people with T1D.

The T1D Exchange QIC has five articles in this edition of Clinical Diabetes. Check out each of the articles, summarized and linked below!

T1D Exchange Quality Improvement Collaborative: A Learning Health System to Improve Outcomes for All People With Type 1 Diabetes

In 2016, T1D Exchange established the QIC with 10 pilot sites. Since then, the QIC has continued to expand, now encompassing 40 centers (13 Adult and 27 Pediatric Centers) that strive to improve care delivery and health outcomes and reduce barriers to care for everyone with type 1 diabetes (T1D) by sharing best practices and data benchmarking.

Reports in this special collection of articles highlight the value of using quality improvement approaches within a learning network to reveal systemic barriers and health care disparities and to improve real-world outcomes. The publications in this special collection describe promising early results from some of the work emanating from this learning network.

The results reported in this special collection from the T1D Exchange QIC are encouraging, but the full potential of this learning network to improve outcomes and reduce disparities is yet to be reached. Hopefully, even greater change will soon be realized.

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Multi-Clinic Quality Improvement Initiative Increases Continuous Glucose Monitoring Use Among Adolescents and Young Adults with Type 1 Diabetes

Continuous glucose monitoring (CGM) use is associated with improved A1C outcomes and quality of life in adolescents and young adults with T1D, however CGM uptake is low. This article reports on a quality improvement initiative of the T1D Exchange QIC to increase CGM use among patients in this age group.

Ten diabetes centers participated in developing a list of improvement ideas and center-specific interventions that increased CGM use from 34% to 55% in adolescents and young adults for 19–22 months.

Sites that performed quality improvement tests and documented their interventions had the highest increases in CGM uptake. This demonstrates that the quality improvement methodology of trying new approaches to T1D care and sharing out the learnings from those tests can increase CGM uptake.

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Inequities in Health Outcomes in Children and Adults with Type 1 Diabetes: Data from the T1D Exchange Collaborative

Health care inequities among racial and ethnic groups remain prevalent. For people with T1D who require increased medical access and care, we see striking inequities in glycemic outcomes, acute diabetes complications, and technology use among different racial and ethnic groups.

This article reports on a study by the T1D Exchange QIC evaluating differences in A1c, diabetes-related ketoacidosis (DKA), severe hypoglycemia, and technology use among racial and ethnic groups.

In this study, average A1c levels were found to be higher in Hispanic and non-Hispanic Black people with T1D, compared with the non-Hispanic White population. Instances of DKA and severe hypoglycemia use were also significantly higher in non-Hispanic Black people with T1D.

Based on this data, it is imperative that we investigate possible causes for these differences, and that we develop interventions that specifically focus on Black and Hispanic individuals to improve their diabetes care and decrease racial and ethnic health inequities.

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Increasing Insulin Pump Use among 12-26 Year Olds with Type 1 Diabetes: Results from the T1D Exchange Quality Improvement Collaborative

Insulin pump therapy in children with T1D has been associated with better glycemic control than multiple daily injections. However, insulin pump use remains limited.

This article describes an initiative from the T1D Exchange QIC aimed at increasing insulin pump use in people with T1D aged 12–26 years, starting from 45% in May 2018 and aiming to reach more than 50% by February 2020.

Interventions developed by participating centers included increasing in-person and telehealth education about insulin pump technology, creating, and distributing tools to help people with T1D make informed decisions, facilitating insulin pump insurance approval and onboarding processes, and improving clinic staff knowledge about insulin pumps.

These efforts showed a 13% improvement in pump use among the participating centers, from 45% to 58% over 22 months.

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Quality Improvement in Diabetes Care: A Review of Initiatives and Outcomes in the T1D Exchange QI Collaborative

The quality improvement model of reporting and benchmarking outcomes prompted the development of the T1D Exchange QIC, which focuses the quality improvement approach on type 1 diabetes.

As the QIC matured, multiple interventions in T1D care have been enacted and evaluated across several areas. Most of these initiatives have focused on three key areas: care delivery, self-management, and psychosocial support.

This article reviews the T1D Exchange QIC initiatives that have been implemented to improve the care people with T1D receive and their health outcomes.

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