Advancing Equity in Diabetes Technology: T1D Exchange QI Collaborative Multicenter Quality Improvement Project across Adult and Pediatric Centers
Author Block: ORI ODUGBESAN, NICOLE RIOLES, TREVON WRIGHT, TIMOTHY R. BOL, GEORGIA DAVIS, CARLA DEMETERCO-BERGGREN, EMMA EDMONDSON, HALIS K. AKTURK, STEPHANIE OGBURN, CANDICE A. WILLIAMS, FRANCESCO VENDRAME, Boston, MA, Atlanta, GA, San Diego, CA, Philadelphia, PA, Aurora, CO, Fort Worth, TX, Miami, FL
Introduction and Objective: Despite evidence that diabetes technologies improve glycemic outcomes, inequities in device use persist across racial and ethnic groups. Building on a prior pilot, the T1D Exchange Quality Improvement Collaborative (T1DX-QI) launched an equity expansion project to validate interventions, promote sustainability, and broaden the scope to include connected insulin pens (CIPs) in addition to CGM and insulin pumps. Project aims to increase equitable use of CGM, insulin pumps and CIPs.
Methods: Nine centers participated in the multicenter project. Participating centers utilized the T1DX-QI heath equity framework. Sites applied tools including process maps, fishbone diagrams, and Plan-Do-Study-Act (PDSA) cycles to test interventions locally. Sample interventions included chart reviews to facilitate shared decision making, use of disparities questionnaires to identify and address barriers, in-clinic interpreter support, early education at diagnosis, bias training for clinicians, streamlined device prescription processes, patient and provider education, and assistance to reduce out-of-pocket cost. All nine centers implemented interventions to increase CGM and insulin pump use while three centers tested interventions to increase CIP use.
Results: Seven of 9 centers achieved higher CGM and pump use across all racial/ethnic groups. Two of 3 centers increased CIPs use. Five out of 9 centers reduced the equity gap in CGM and pump use between Non-Hispanic White (NHW) and Non-Hispanic Black and between NHW and Hispanic populations.
Conclusion: This multi-center equity project demonstrated that a structured QI approach can advance equity in diabetes technology use. Tailored interventions improved CGM, pump, and CIP adoption across racial and ethnic groups
