Activity
- 6 hours, 14 minutes ago
  
  Bonnie Lundblom likes your comment at
  Have you ever switched to a new insulin pump or CGM only to return to your previous version?
  I didn't change, but I was thinking of changing back to the Dexcom G6 from the G7 since G6 are going to eventually be discontinued. Once I learned some tricks to use the G7 more effectively, I am getting less problems with it.
- 13 hours, 17 minutes ago
  
  Bret Itskowitch likes your comment at
  How have you managed glucose levels for yourself (or a child living with T1D) at a waterpark or amusement park?
  The same as I would anyplace else. Check my numbers frequently, not skip meals, keep hydrated and take snacks when needed.
- 13 hours, 42 minutes ago
  
  Carl Robertson likes your comment at
  Do you use creams or ointments on your skin BEFORE inserting a T1D device?
  I never use creams or ointments but I do use IV Prep before placing an infusion set and alcohol before placing my CGM sensor.
- 14 hours, 18 minutes ago
  
  Bill Williams likes your comment at
  How have you managed glucose levels for yourself (or a child living with T1D) at a waterpark or amusement park?
  glucose meter and multiple injections
- 14 hours, 19 minutes ago
  
  Bill Williams likes your comment at
  How have you managed glucose levels for yourself (or a child living with T1D) at a waterpark or amusement park?
  The same as I would anyplace else. Check my numbers frequently, not skip meals, keep hydrated and take snacks when needed.
- 14 hours, 24 minutes ago
  
  Vicki Andersen likes your comment at
  How have you managed glucose levels for yourself (or a child living with T1D) at a waterpark or amusement park?
  The same as I would anyplace else. Check my numbers frequently, not skip meals, keep hydrated and take snacks when needed.
- 14 hours, 28 minutes ago
  
  lis be likes your comment at
  Do you use creams or ointments on your skin BEFORE inserting a T1D device?
  I was taught to never put anything on my skin before inserting a sensor to avoid contaminating the sensor with something that could interfere with accurate glucose readings. I do use Skin Prep (Smith and Nephew) under infusion sites to minimize irritation from the adhesive but not creams or ointments.
- 14 hours, 31 minutes ago
  
  lis be likes your comment at
  Which glucose metric is most important to you?
  Here's a refence to GMI https://diabetesjournals.org/care/article/47/9/e74/157126/Comment-on-Selvin-et-al-The-Glucose-Management I’ll paraphrase, but basically it says GMI is pretty feeble, at best. I use TIR, however the moats many of us are building around cherished ideas may be much shallower than we’ve hoped.
- 14 hours, 31 minutes ago
  
  lis be likes your comment at
  Which glucose metric is most important to you?
  I put all three, but TIR is probably the most important. But of course TIR can be 100% and your blood sugar average around 170 which is way too high for an average. That is why I believe a combination of of all are important including standard deviation.
- 14 hours, 32 minutes ago
  
  lis be likes your comment at
  Which glucose metric is most important to you?
  TIR can only be improved by decreasing variability. I feel best 70-180 (maybe really 150) and that is most important to me. Feeling my best and reducing the burden of T1d management is my goal. I have reached that using open-source Loop!!
- 15 hours, 10 minutes ago
  
  Lawrence S. likes your comment at
  How have you managed glucose levels for yourself (or a child living with T1D) at a waterpark or amusement park?
  When I wen to Dismay World in Orlando, I just watched my meter, took frequent breaks and kept hydrated. I also placed a we cloth around my neck to keep me cooler.
- 15 hours, 11 minutes ago
  
  Lawrence S. likes your comment at
  How have you managed glucose levels for yourself (or a child living with T1D) at a waterpark or amusement park?
  The same as I would anyplace else. Check my numbers frequently, not skip meals, keep hydrated and take snacks when needed.
- 16 hours, 14 minutes ago
  
  Susan Wood likes your comment at
  How have you managed glucose levels for yourself (or a child living with T1D) at a waterpark or amusement park?
  The same as I would anyplace else. Check my numbers frequently, not skip meals, keep hydrated and take snacks when needed.
- 16 hours, 15 minutes ago
  
  Marty likes your comment at
  If you are having DKA-like symptoms, what steps do you take? Please select all that apply and explain more in the comments.
  One item was missed...take some fast acting insulin.
- 16 hours, 24 minutes ago
  
  Tom Caesar likes your comment at
  How have you managed glucose levels for yourself (or a child living with T1D) at a waterpark or amusement park?
  The same as I would anyplace else. Check my numbers frequently, not skip meals, keep hydrated and take snacks when needed.
- 1 day, 10 hours ago
  
  Anita Stokar likes your comment at
  If you are having DKA-like symptoms, what steps do you take? Please select all that apply and explain more in the comments.
  One item was missed...take some fast acting insulin.
- 1 day, 15 hours ago
  
  KarenM6 likes your comment at
  If you are having DKA-like symptoms, what steps do you take? Please select all that apply and explain more in the comments.
  One item was missed...take some fast acting insulin.
- 1 day, 18 hours ago
  
  Melissa Childers likes your comment at
  If you are having DKA-like symptoms, what steps do you take? Please select all that apply and explain more in the comments.
  One item was missed...take some fast acting insulin.
- 1 day, 20 hours ago
  
  Jaysen LeSage likes your comment at
  If you are having DKA-like symptoms, what steps do you take? Please select all that apply and explain more in the comments.
  One item was missed...take some fast acting insulin.
- 1 day, 20 hours ago
  
  Jaysen LeSage likes your comment at
  If you are having DKA-like symptoms, what steps do you take? Please select all that apply and explain more in the comments.
  DKA should never be an issue except during the initial diagnosis. Managing T1D takes care of that issue.
- 2 days, 9 hours ago
  
  eherban1 likes your comment at
  If you are having DKA-like symptoms, what steps do you take? Please select all that apply and explain more in the comments.
  I have not experienced DKA, to my knowledge, since 1978, however, I know first hand it is a life threatening condition.
- 2 days, 12 hours ago
  
  Sandra Norman likes your comment at
  If you are having DKA-like symptoms, what steps do you take? Please select all that apply and explain more in the comments.
  One item was missed...take some fast acting insulin.
- 2 days, 12 hours ago
  
  Tracy Jean likes your comment at
  If you are having DKA-like symptoms, what steps do you take? Please select all that apply and explain more in the comments.
  Check my bg with a glucometer then give 1.5 times the amount of insulin it tells me to take. Check with a glucometer again in 1 hour and keep doing that until my bg comes down into normal range.
- 2 days, 13 hours ago
  
  Dennis Dacey likes your comment at
  If you are having DKA-like symptoms, what steps do you take? Please select all that apply and explain more in the comments.
  I last had DKA when I was diagnosed with T1D in 1970. Today my CGM provides sufficient information to avoid DKA.
- 2 days, 13 hours ago
  
  Dennis Dacey likes your comment at
  If you are having DKA-like symptoms, what steps do you take? Please select all that apply and explain more in the comments.
  Proper self-management is all that is needed. I’ve just begun my 57th year.
Clear All

T1DX-QI Updates: Insulin Delivery Methods, Inclusive Care, and More

Sarah Howard, 19 hours ago 0 5 min read

The T1D Exchange Quality Improvement Collaborative (T1DX-QI) comprises 60+ endocrinology centers across the US, collectively caring for over 160,000 people living with type 1 and type 2 diabetes.  

Our quality improvement coaches and data scientists work with healthcare providers at T1DX-QI member clinics to identify areas of unmet need, use data benchmarking, refine best practices, and implement evidence-based solutions that improve care and outcomes for people with diabetes.  

This article delves into several recent research publications and presentations spearheaded by the T1DX-QI. These studies illustrate the collaborative’s efforts to improve glycemic outcomes, increase the use of diabetes technologies, and improve the overall care provided to people living with diabetes.

Learn more about our findings from each of these research studies:

Implementing High-Risk Programs at Four Pediatric Endocrinology Clinics in the T1D Exchange QI Collaborative
Improving glycemic outcomes for children and adolescents with type 1 diabetes: a T1DX-QI success story
Insulin Delivery Devices in Management of T1D Among Pediatric Patients
LGBTQ+ Supportive and Inclusive Care Practices: Survey Data from the T1D Exchange Quality Improvement Collaborative
The Impact of War and Conflict on People Living with Diabetes: A Scoping Review
Treatment Regimens and Glycemic Outcomes in More Than 100,000 Children with Type 1 Diabetes (2013–22): A Longitudinal Analysis of Data from Pediatric Diabetes Registries

Implementing High-Risk Programs at Four Pediatric Endocrinology Clinics in the T1D Exchange QI Collaborative

The T1DX-QI piloted new high-risk programs at four pediatric diabetes clinics to help children with diabetes reach lower A1Cs.

The clinics created supportive programs for children with A1Cs of 9% or above. Rather than labeling these initiatives as “high-risk programs,” they emphasized the positive and supportive aspects of diabetes care.

The programs included a caring team of healthcare providers and educators who created personalized care plans for each child. These plans included education, regular check-ups, and person-centered care to meet individual needs.

Over 17 months, the average A1C levels among the children in these programs dropped by 2.5%. The study showed that supportive, personalized care can help improve outcomes for children with higher A1Cs.

Read this abstract and all abstracts from the 2024 T1DX-QI Learning Session.

Improving glycemic outcomes for children and adolescents with type 1 diabetes: a T1DX-QI success story

This study, presented at the International Society for Pediatric and Adolescent Diabetes’s 50th Annual Conference in October 2024, looked at how glycemic outcomes and diabetes device usage have changed at Rady Children’s Hospital-San Diego since they joined the T1DX-QI.

Participation in learning collaboratives can support benchmarking among clinics, executing improvement projects, and making system-level changes in the real world. Through their work with the T1DX-QI, Rady Children’s Hospital-San Diego aimed to increase the use of diabetes technologies like continuous glucose monitors (CGMs) and insulin pumps, encourage more frequent clinic visits, and provide better support for at-risk children.

Over four years, we found the following improvements:

CGM usage rose from about 60% to over 90%.
Insulin pump usage increased from about 29% to 50%.
Average A1C dropped from 8.7% to 8.1%.
The number of children with an A1C below 7% increased by 11.3%.

In summary, sharing best practices and using improvement science through the T1DX-QI may have led to increased use of essential diabetes tech and improved glucose management in young people with type 1 diabetes.

Read the full abstract on page 191 of the 2024 ISPAD Abstract Book.

Insulin Delivery Devices in Management of T1D Among Pediatric Patients

Jackson Medical Health System/University of Miami, an endocrinology center in the T1DX-QI, conducted a study to compare different insulin delivery methods for children with type 1 diabetes and their impact on A1Cs.

The methods studied included multiple daily injections, smart pens, insulin pumps without automated insulin delivery (non-hybrid pumps), and automated insulin delivery systems (hybrid insulin pumps.)

Overall usage of each insulin delivery method:

Hybrid pumps: 44%
Non-hybrid pumps: 8%
Smart pens: 24%
Multiple daily injections: 25%

The study found that hybrid pump users had the lowest median A1C, and non-hybrid pump users had the second lowest. The highest median A1C was among smartpen users.

The success of insulin delivery devices varied among the three healthcare providers involved in this study and their patients. The study notes that Provider 2’s patients mostly had public insurance. Other factors, such as a person’s device preference and correct usage, might also influence these results.

Read this abstract and all abstracts from the 2024 T1DX-QI Learning Session.

LGBTQ+ Supportive and Inclusive Care Practices: Survey Data from the T1D Exchange Quality Improvement Collaborative

Living with type 1 diabetes is tough, and LGBTQ+ (lesbian, gay, bisexual, transgender, queer, or other gender-expansive identities) individuals can face additional barriers.

Recognizing the need for personalized care for these individuals, the Health Resources and Services Administration requires medical centers to document their patients’ sexual orientation and gender identity (SOGI). We surveyed 50 diabetes care centers in the T1DX-QI to understand the current practices around documenting this information.

Here’s what we learned:

64% of pediatric centers had strategies in place for SOGI documentation.
50% of adult centers had implemented strategies for SOGI documentation.
Some adult centers could not confirm whether they recorded this information.

Overall, while most centers recorded gender identity and pronouns, fewer documented sexual orientation. More work is needed to standardize SOGI documentation practices and to understand its impact on LGBTQ+ people with diabetes.

Read the full article in DiabetesSpectrum.

The Impact of War and Conflict on People Living with Diabetes: A Scoping Review

War and conflict can severely affect people living with diabetes. The T1DX-QI reviewed research from 1950 to 2023 to understand how war impacts diabetes management and health.

The findings highlighted three main issues:

People in war zones often have higher glucose levels.
The stress of living in conflict areas makes it harder for people to manage their diabetes and reduces their quality of life.
Access to healthcare, including necessary medications and services, is often disrupted during war.

Overall, the findings emphasize the profound impact of war and conflict on people living with diabetes. This review shows a need for more research to identify the factors that worsen these challenges and find ways to help people with diabetes in conflict settings.

Read the full review in Clinical Diabetology.

Tags #research highlights #T1D Exchange Quality Improvement Collaborative

Sarah Howard

Sarah Howard (nee Tackett) has dedicated her career to supporting the T1D community ever since she was diagnosed with T1D while in college in May 2013. Since then, she has worked for various diabetes organizations, focusing on research, advocacy, and community-building efforts for people with T1D and their loved ones. Sarah is currently the Senior Manager of Marketing at T1D Exchange.