Increasing Adoption of Diabetes Technology among Children and Youth with Type 1 Diabetes: T1D Exchange Quality Improvement Collaborative

 

Author Block: ORI ODUGBESAN, TIMOTHY R. BOL, TREVON WRIGHT, NAOMI FOGEL, MARY PAT GALLAGHER, PATRICK C. HANLEY, ROBERTO E. IZQUIERDO, ELIZABETH A. MANN, ALISSA ROBERTS, JANINE SANCHEZ, ALISSA GUARNERI, KRISTINA COSSEN, CARLA DEMETERCO-BERGGREN, RISA WOLF, JENISE C. WONG, GUY T. ALONSO, MANMOHAN K. KAMBOJ, NICOLE RIOLES, Boston, MA, Chicago, IL, New York, NY, Wilmington, DE, Syracuse, NY, Madison, WI, Seattle, WA, Miami, FL, Pittsburgh, PA, Atlanta, GA, San Diego, CA, Baltimore, MD, San Francisco, CA, Colorado, CO, Columbus, OH

Introduction and Objective: Continuous Glucose Monitoring (CGM) and Automated Insulin Delivery (AID) systems improve type 1 diabetes management. CGM is recommended as standard of care for pediatric type 1 diabetes management. AID systems improve blood glucose levels and quality of life for children. The T1D Exchange Quality Improvement Collaborative supports participating centers in implementing system-level interventions to increase access to diabetes technology


Methods: Monthly data from 1/2023 to 9/2025 were aggregated from 25 pediatric centers that applied quality improvement (QI) principles, including the Ishikawa diagram, process map, effort/impact matrix tool, and Plan - Do - Study - Act cycles to test and expand QI interventions. Statistical process control charts were used to assess trends in CGM and AID use


Results: CGM use increased from 83% to 91%, representing a sustained improvement with an upward shift in the centerline. AID use increased from 58% to 64%. Both measures demonstrated upward shifts over time, with multiple centers achieving performance above their pre-intervention baselines


Conclusion: Implementation of QI intervention across clinics was associated with sustained increases in CGM use and AID adoption. These improvements demonstrate that system-level interventions targeting workflow redesign, patient engagement, and reducing barriers can successfully increase diabetes technology utilization in clinical settings


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