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The T1D Exchange Quality Improvement Collaborative (T1DX-QI) published 18 manuscripts during 2022. This variety of robust and deeply impactful work shares the same goal: helping people with type 1 diabetes achieve the best possible health and quality of life.
Here’s a look at this year’s published work thanks to the dedication and energy of clinicians and researchers in 52 participating clinics across the country. This work was presented at multiple conferences around the world — including ADA 2022, ATTD 2022, ADCES 2022, and ISPAD 2022.
Diabetes status and other factors correlating risk for thrombotic and thromboembolic events during SARS-CoV-2 infection
BMJ Open Diabetes Research & Care
“We examined diabetes status (no diabetes; type 1 diabetes [T1D]; type 2 diabetes [T2D]) and other demographic and clinical factors as correlates of coronavirus disease 2019 (COVID-19)-related hospitalization.” explains the study. “Further, we evaluated predictors of COVID-19-related hospitalization in T1D and T2D. The higher hospitalization risk in T1D versus T2D warrants further investigation. Modifiable risk factors such as vitamin D deficiency/insufficiency, BMI, and elevated HbA1c may serve as prognostic indicators for COVID-19-related hospitalization in adults with diabetes.”
Baseline Quality Improvement Capacity of 33 Endocrinology Centers Participating in the T1D Exchange QI Collaborative
“Since its inception eight years ago, the [T1D Exchange Quality Improvement Collaborative has expanded to include centers across the United States with varying levels of QI experience, while simultaneously achieving many tangible improvements in type 1 diabetes care,” explains the study. “These successes underscore the importance of learning health systems, data-sharing, benchmarking, and peer collaboration as drivers for continuous QI.”
Reflections from the T1D Exchange Quality Improvement Collaborative
“There have been remarkable innovations in diabetes management since the start of the COVID-19 pandemic, but these groundbreaking innovations are drawing limited focus as the field focuses on the adverse impact of the pandemic on patients with diabetes,” explains the study. “This article reviews select population health innovations in diabetes management that have become available over the past 2 years of the COVID-19 pandemic from the perspective of the T1D Exchange Quality Improvement Collaborative.”
Commentary on the T1D Exchange Quality Improvement Collaborative Learning Session November 2022 Abstracts
A deep dive into the impressive variety of work presented at Learning Sessions 2022 by participating clinics working to improve patient care and outcomes. Read more highlights here: Day 1 and Day 2.
“T1DX will continue to search for new ways to drive change for patients and their families, using novel QI methodology, stakeholder engagement, and data-driven approaches,” explains the commentary. “Future directions may include diabetes technology data integration in the electronic medical record, new psychosocial care models that address highly prevalent psychological issues in people with T1D, and shared decision aids that promote patient-centered care in diabetes.”
Using Real World Data and Quality Improvement to Advance Diabetes Outcomes
“Individuals with type 1 diabetes may struggle with diabetes management at various times throughout their lives because of physiological and psychosocial changes,” explains the study. “Identifying factors associated with optimal diabetes management can provide opportunities for health care teams to implement real-time changes for improvement.”
Facilitators and Barriers to Smart Insulin Pen Use
“High-impact barriers included insurance coverage and prescribing processes; high-impact facilitators included improved diabetes clinic visit quality and use of SIPs as an alternative to insulin pump therapy,” explains the study. “Findings indicated the need for provider and care team education and training on proper SIP features, use, and prescribing.”
Factors Associated with Improved Hemoglobin A1c Among Adults with T1D in the U.S.
“Many adults with diabetes do not reach optimal glycemic targets, and, despite advances in diabetes management, diabetes technology use remains significantly lower in racial/ethnic minority groups,” explains the study. “Individuals attaining the target A1C were more likely to be older, White, have private health insurance, and use diabetes technology and less likely to report depressive symptoms or episodes of severe hypoglycemia or diabetic ketoacidosis than those with higher A1C levels. These findings highlight the importance of overcoming inequities in diabetes care.”
Comorbidities Increase COVID-19 Hospitalization in Young people with Type 1 Diabetes
“This cross-sectional study included questionnaire data on patients <25 years of age with established T1D and laboratory-confirmed COVID-19 from 52 sites across the US between April 2020 and October 2021,” explains the study. “Our findings show that comorbidities increase the risk for hospitalization with COVID-19 in children and young adults highlighting the need for tailored COVID-19 prevention and treatment strategies in T1D.”
Promoting Benchmarking and Population Health Improvement Using the T1D Exchange Quality Improvement Portal Collaborative
“This article describes how the T1D Exchange Quality Improvement Collaborative leverages an innovative web platform, the QI Portal, to gather and store electronic medical record (EMR) data to promote benchmarking and population health improvement in a type 1 diabetes learning health system,” explains the study. “The authors explain the value of the QI Portal, the process for mapping center-level data from EMRs using standardized data specifications, and the QI Portal’s unique features for advancing population health.”
Factors Associated with Achieving Target HbA1c in Children and Adolescents with Type 1 Diabetes
“The optimal care of type 1 diabetes involves consistent glycemic management to avoid short-and long-term complications,” explains the study. “However, despite advancements in diabetes technology and standards, achieving adequate glycemic levels in children and adolescents remains a challenge. This study aimed to identify factors associated with achieving the recommended A1C target of <7% from the United States–based multicenter T1D Exchange Quality Improvement Collaborative cohort, including 25,383 children and adolescents living with type 1 diabetes.”
Transatlantic Comparison of Pediatric Continuous Glucose Monitoring Use in the DPV Initiative and T1D Exchange Quality Improvement Collaborative
Diabetes Technology and Therapeutics
“Achieving glycemic targets in youth and young adults with type 1 diabetes (T1D) is challenging,” explains the study. “We analyzed the proportion of CGM use in youth and young adults with T1D at nine U.S. T1D Exchange Quality Improvement (T1DX-QI) Collaborative centers and 402 European diabetes prospective follow-up registry (Diabetes-Patienten-Verlaufsdokumentation [DPV]) sites from 2017 to 2020 and examined the association of CGM use to glycemic control as measured by hemoglobin A1c (HbA1c). CGM use appeared to increase more so in the European DPV than the U.S. T1DX-QI, which may be due to transatlantic differences in health care systems, insurance coverage, and prescriber habits.”
A Collaborative Comparison of International Pediatric Diabetes Registries
“Principal investigators from seven well-established longitudinal pediatric diabetes registries and the SWEET initiative have come together to provide an international collaborative perspective and comparison of the registries represented, identifying similarities and differences, with a view to provide information for countries/regions that are interested in establishing a registry and to foster future international collaboration.”
Hybrid Closed Loop Systems and Glycemic Outcomes in Children and Adults with Type 1 Diabetes
“Increasing evidence demonstrates the benefits of new diabetes technologies, including insulin pumps and continuous glucose monitors (CGM), for glycemic management in people with type 1 diabetes (T1D),” explains the study. “In addition to the independent use of these technologies, hybrid closed-loop systems (HCLS), which combine insulin pumps and CGM with a closed-loop algorithm controller to automate insulin delivery, can improve glucose levels. This study compared glycemic outcomes in users of HCLS with those of users of insulin pumps and CGM without automated insulin delivery and those using multiple daily insulin injections (MDI) with CGM in youth and adults with T1D.”
Implicit Racial-Ethnic and Insurance Mediated Bias to Recommending Diabetes Technology
Diabetes Technology and Therapeutics
“Despite documented benefits of diabetes technology in managing type 1 diabetes, inequities persist in the use of these devices,” explains the study. “Provider bias may be a driver of inequities, but the evidence is limited. Therefore, we aimed to examine the role of race/ethnicity and insurance-mediated provider implicit bias in recommending diabetes technology. Provider implicit bias to recommend diabetes technology was observed based on insurance and Race/Ethnicity in our pediatric and adult diabetes provider cohort. These data raise the need to address provider implicit bias in diabetes care.”
Trends in Type 1 Diabetic Ketoacidosis During COVID-19 Surges at Seven US Centers: Highest Burden on Non-Hispanic Blacks
Journal of Clinical Endocrinology & Medicine
“The impact of the COVID-19 pandemic on individuals with type 1 diabetes remains poorly defined,” explains the study. “We compared DKA events among children and adults with T1D during COVID-19 surge 1 (March-May 2020) and COVID-19 surge 2 (August-October 2020) to the same periods in 2019. Analysis was performed using descriptive statistics and chi-square tests. DKA frequency increased among T1D patients during COVID-19 surges with highest frequency among NHB patients.”
Achieving Equity in Diabetes Research: Borrowing from the Field of Quality Improvement Using A Practical Framework and Improvement Tools
“There are limited tools to address equity in diabetes research and clinical trials,” explains the study. “The T1D Exchange Quality Improvement Collaborative has established a 10-step equity framework to advance equity in diabetes research. Herein, the authors outline this approach and expand on its practical application.”
Increase in Newly Diagnoses Type 1 Diabetes in Youth During the COVID-19 Pandemic in the U.S.
“An increase in newly diagnosed type 1 diabetes (T1D) has been posited during the COVID-19 pandemic, but data are conflicting,” explains the study. “We aimed to determine trends in newly diagnosed T1D and severity of presentation at diagnosis for pediatric and adolescent patients during COVID-19 (2020) as compared to the previous year (2019) in a multi-center analysis across the United States. We found an increase in newly diagnosed T1D and a greater proportion presenting in DKA at diagnosis during the COVID-19 pandemic compared to the prior year.”
Differences in COVID-19 Outcomes Among Patients with Type 1 Diabetes: First vs. Late Surges
Journal of Clinical Outcomes Management 2022
“Patient outcomes of COVID-19 have improved throughout the pandemic. However, because it is not known whether outcomes of COVID-19 in the type 1 diabetes (T1D) population improved over time, we investigated differences in COVID-19 outcomes for patients with T1D in the United States,” explains the study. “Patients with T1D who presented with COVID-19 during the first surge had a higher proportion of adverse outcomes than those who presented in a later surge.”
And we’re only getting started! Thanks to dedicated care and expertise of our participating clinics, this great work to improve life for people with T1D continues!
