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Findings show disparities in technology use and diabetes outcomes among T1D community; Reinforce the promise of quality improvement and real-world data to inform more equitable and improved care.
BOSTON, June 25, 2021 /PRNewswire/ — T1D Exchange, a nonprofit organization that drives meaningful research and innovation in treatment of type 1 diabetes (T1D), today announced that new real-world data from both its Quality Improvement Collaborative (QIC) and its online patient Registry will be shared in one oral presentation and nine additional poster presentations during the American Diabetes Association (ADA) 81st Scientific Sessions, held virtually June 25-29. The studies detail continued inequities in T1D care, including disparities with technology use and glycemic target outcomes; they also highlight a pathway to more equitable care and improved health outcomes through consistent system-wide quality improvement initiatives and patient-sourced data and insights. A full list of abstracts can be found here.
“By examining real-world trends in T1D care, we can identify issues and direct our implementation science and quality improvement efforts to drive positive change,” said David Walton, Chief Executive Officer at T1D Exchange. “As a leader in population health research and collaboration, we will continue generating evidence for the diabetes community to help improve care for all, and resolve persisting inequities and disparities for the 1.6 million people living with T1D in the U.S.”
About the T1D Exchange QIC and the T1D Exchange Registry
The T1D Exchange Quality Improvement Collaborative (QIC) brings together 40 diabetes clinics across the U.S., collectively treating more than 55,000 T1D patients, to identify and address gaps in care and accelerate evidence-based, practical solutions. Participating clinics contribute anonymized patient data and research from their respective clinics, expanding the collective knowledge base and creating a unified data asset to expedite improvements in care for all people living with T1D.
The T1D Exchange Registry tracks disease progress over time and to date includes over 14,000 people living with T1D in the U.S. It gathers information directly from these individuals, including data on disease management and outcomes, connecting patients to research and researchers to patients. Participants complete annual surveys and the Registry curates other research opportunities to advance meaningful treatment, care and policy. The focus is to ensure representation across the T1D community, including patient populations often underrepresented in clinical studies.
Since the beginning of 2020, both initiatives have seen significant growth: The QIC has more than tripled in number of clinics, and the Registry has more than doubled in number of participants.
T1D Exchange QIC Presentation Highlights
- HbA1c Trends in the T1D Exchange Quality Improvement Collaborative (QIC) 2017-2020
An analysis comparing patient data from the T1D Exchange Clinic Registry and the QIC in 2017 and in 2020 showed that lower A1c levels correlated with the presence of quality improvement programs. Mean A1c levels were higher in 2017—when clinics first began implementing practice-wide QI initiatives—than in 2020. Improvements in insulin pump use, continuous glucose monitor (CGM) use, and intentional population health management of patients with A1c greater than nine also contributed to the positive A1c trends.
“This is encouraging news for the type 1 diabetes community,” said Osagie Ebekozien, MD, MPH, CPHQ, Vice President of Quality Improvement and Population Health at T1D Exchange. “Prior data showed worsening A1c trends from 2010 to 20181 but our preliminary data demonstrates the potential to reverse this through rigorous, systematic quality improvement and intentional population health management, augmented by increased use of technology. These efforts may substantially move the needle to advance patient care for all.”
- Insulin Pump Use in Patients with T1D: Real-World Data from a Large U.S. Based Multi-Center Observational Study
An analysis of outcomes among 21,821 T1D patients (age 2+) in the T1D Exchange QIC database between 2014 and 2020 showed inequities in insulin pump and CGM use in effective blood glucose management. The study is one of the largest multi-center observational examinations of real-world outcomes data in the U.S. and this analysis is the first reporting of QIC data over a six-year period. Findings include:
- 58% of patients were insulin pump users; 42% were non-users.
- A1c levels were lower in the insulin pump group compared to non-users.
- 60% of non-Hispanic white T1D patients used insulin pumps, while less than 40% of non-Hispanic Black T1D patients used pumps for glycemic improvement.
- Six Habits: Quality Metrics to Support Glycemic Outcomes in T1D
Data examining the relationship between six T1D self-management habits showed that A1c levels were significantly lower for those who performed each habit (e.g., using an insulin pump, checking blood glucose ≥4 times a day). The study suggests that inequities in care can impact outcomes and that data and insights measuring quality improvements can be used to advance care, leading to improved outcomes. As a result, the six habits will be adopted by QIC centers to support interventions to improve glycemic management.
T1D Exchange Registry Presentation Highlights
- T1D Exchange Registry: Current Insights on Participant Outcomes
Findings presented at ADA are the first reporting of data on the annual questionnaire from the T1D Exchange Registry. Data show that this subset of Registry participants are highly engaged technology users and meet target A1c levels, but still report hypoglycemia and diabetic ketoacidosis (DKA) symptoms—suggesting there is potential to improve diabetes management and care. Key findings include:
- The average A1c level was 6.8 at the one-year questionnaire and 7.2 at the initial questionnaire.
- 15% reported experiencing severe hypoglycemia.
- Approximately 7% reported DKA symptoms over the last 12 months.
“This data show that these highly engaged Registry participants are doing well meeting their A1c levels with support from advanced technology, which is fantastic, but there is still room for therapeutic improvement and uptake of diabetes technology,” said Wendy Wolf, Vice President of Registry and Outcomes Research at T1D Exchange. “There are few large U.S. datasets like our Registry that are capturing the authentic experience of people living with T1D. By understanding how people self-manage their disease, the community receives a more complete picture than relying on clinical data alone.”
Data Published in JCEM on COVID-19
The studies being presented at ADA build on recent work by T1D Exchange that examine the inequities that exist in T1D care, including a first-of-its-kind study analyzing racial-ethnic disparities for people with T1D and COVID-19 infection published in the Journal of Clinical Endocrinology & Metabolism. To learn more about the study, click here.
About T1D Exchange
T1D Exchange is a leader in harnessing data to advance T1D care and outcomes by driving collaborative change. Through real-world evidence and clinical data collection and analysis, our novel insights are identifying gaps in data and redefining best practices to improve the lives of those living with T1D. T1D Exchange actively supports quality improvement and innovation through its Quality Improvement Collaborative (QIC), patient registry, and data-oriented research services. Through a knowledge-sharing and collaboration-focused approach, T1D Exchange is accelerating real-world impacts by providing clinicians, researchers, industry partners and advocates with the resources and services they need for better decision support and population health management. A nonprofit organization, T1D Exchange was established in 2010 with ongoing support from The Leona M. and Harry B. Helmsley Charitable Trust.
To learn more about QIC member clinics, click here. For more information on the Registry, visit www.t1dregistry.org.
New T1D Exchange Data at American Diabetes Association 81st Scientific Sessions Highlight Patient Care Inequities Cancel reply
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So if a Type 1 decides to try an extremely low carb diet (less than 10g net carbohydrates per day) and the result is acetone in the urine and less hypoglycemia and less insulin and lower average blood glucose levels and less body fat and greater muscle mass and more exercise, is this person put in the same slot as an undiagnosed or poorly controlled T1 using no insulin and eating high carb diet resulting in ketoacidosis? Should there be a distinction?