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The T1D Exchange Quality Improvement Collaborative (QIC) was established in 2016 — with the support of The Leona M. and Harry B. Helmsley Charitable Trust — in an effort to refine best practices, and improve quality of care and outcomes, for individuals living with T1D. Growth has been tremendous, with 40 endocrine clinics from across the U.S. participating in the Collaborative.
Fueled by top leaders in diabetes care, the QIC has become an engine of innovation and inspiration. By engaging with the shared, data-driven, and systematic methods of the QIC, clinics have seen unprecedented success in their approach to diabetes management.
With members working closely together to identify gaps in care, discover and refine best practices, and share research — the process has become knowledge sharing at its very best. While collated data gives clinics a clear sense of “where they are,” it also demonstrates “where they can be,” by applying shared, evidence-based methods for improving care.
Interview with Ruth Weinstock, MD, Ph.D
Ruth Weinstock MD, PhD, is a SUNY Distinguished Service Professor, Division Chief of Endocrinology, Diabetes, and Metabolism in the Department of Medicine at Upstate Medical University, Director of the Clinical Research Unit, and Medical Director of the Joslin at Upstate Medical University.
Dr. Weinstock’s career spans the course of 30 years, with clinical research, diabetes care, and training of next-generation diabetes providers. With over 200 research publications under her belt, she’s a wealth of information in the endocrine arena. Dr. Weinstock, the 2021 American Diabetes Association President, Medicine and Science, gave this presidential address at the recent Scientific Sessions.
“I love what I do,” stated Dr. Weinstock, “I’ve been interested in medicine since I was a small girl.” When asked, “Why endocrinology?” She explained that her drive was cemented by bearing witness to the struggles a beloved cousin faced with T1D. Years later, Weinstock would indeed become a physician, with a fellowship in endocrinology.
Career-long diabetes advancements
There’s been major advances in diabetes management, Dr. Weinstock explained. “When I entered medical school, there wasn’t blood glucose monitoring; we measured urine glucose. We didn’t have Insulin analogs that are more physiological, we had animal insulins.”
“Overall, tech has really helped people, especially with continuous glucose monitoring. There’s
new insulin delivery systems — including better insulin pumps — with automated insulin delivery, hybrid, closed-loop systems, and hopefully in the not-to-distant future, closed loop systems.”
While there’s been great advances, managing diabetes is still burdensome, and we don’t have prevention strategies or a cure, said Dr. Weinstock, who also pointed out that there’s a tremendous amount of research going on, with exciting possibilities for the future.
“We need strong advocacy, so the federal government increases research funding and support for diabetes programs. I think the future has never been brighter, but we’re not there yet— we need more research.”
Dr. Weinstock has been pushing change forward through her clinical practice, trials and research, and involvement in the QIC. If there’s one thing that’s clear, it’s her investment in improving the lives of people living with T1D.
“I believe in precision medicine,” explains Dr. Weinstock, “We want the right treatment, to the right person, at the right time. Not everyone’s diabetes is the same, so we need targeted therapies for treatment.”
Health disparities and diabetes
“The Collaborative is wonderful. It brings providers together from all over the country who have a passion to help people with diabetes,” said Dr. Weinstock. “It’s a place where intelligent ideas are born, tested, and shared. This helps everyone to do better.”
“We’ve made great strides helping providers to understand, explore, and discover better ways to deliver diabetes care — to benefit the greatest number of people.” However, disparities remain in the T1D community with regards to unmet healthcare needs, explained Dr. Weinstock. “I’m really proud that the Collaborative is attacking health disparities. We want everyone with T1D to get the best care they can to stay healthy.”
Dr. Weinstock explained that there are two main challenges: we need improved access, and more diabetes research for prevention and curative therapies.
In-clinic quality improvements
Working with the Collaborative has emphasized quality improvement, and everyone from our clinic is involved, explained Dr. Weinstock. “We’re improving processes to take care of more people; we’ve gone from zero depression screenings to over 80 percent, improved CGM use, and our peds group has an initiative to decrease DKA admissions in a subset of children.”
“QI involves asking ourselves —how do we get to where we want to be? And this makes us better,” said Dr. Weinstock. “By looking at deidentified data and comparing ourselves with other places through a centralized portal, we can pinpoint areas to improve.”
“My involvement with the QIC has been very enriching — I’ve learned so much from my colleagues at different centers.” stated Dr. Weinstock, who went on to explain that part of this important work is to publish and share findings broadly, so that everyone with T1D can benefit.
When Dr. Weinstock isn’t working, you’re likely to find her surrounded by four beautiful grandchildren, all under the age of five.
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While I appreciate the advances that have been made, there is still so much more advancement needed. The fact that a perfect balance of insulin, activity, emotions and blood sugar cannot be achieved with a loop system is a shame. For me, the auto-suspend for lows doesn’t work. I’m either dropping too fast with too much insulin still active for the system to catch up, or the insulin suspends for too long and I end up going high. I know the loops work well for some people. I am just VERY sensitive to the newer insulins. Hopefully, new versions of the loop will allow for more personalized settings to be entered. This would help a great deal!