Lee, JM, Garrity, A, Hirschfeld, E, Thomas, IH, Rioles, N, Ebekozien, O, Corathers, S

Objective: To evaluate the relationship of six diabetes self-management habits with Hemoglobin A1c (HbA1c) and by race and insurance.

Methods: Using the electronic health record (EHR), we incorporated six patient-level diabetes self-management metrics into the clinical workflow for visits. Patients were classified as “performing the habit” if they checked glucose ≥4 times/day or used a continuous glucose monitor; administered ≥3 insulin boluses/day; used an insulin pump; bolused insulin before meals; reviewed data between visits; and changed insulin doses between visits. We then calculated a total habit score.

Results: Of 1344 T1D patients seen in 2019, we excluded patients who were new onset (n=57), not on insulin (n=2); missing HbA1c (n=9); or missing documentation (n=64); leaving 1212. HbA1c was significantly lower for those who performed each habit compared with those who did not. For every one-unit increase in total habit score, we found a 0.7% (8 mmol/mol) reduction in HbA1c overall with similar reductions by race and insurance.

Conclusions: The six habits are significantly associated with glycemia and will be adopted by T1D Exchange Quality Improvement Collaborative centers to support interventions to improve glycemic outcomes.