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We are honored to share recent work from the T1D Exchange Quality Improvement Collaborative (T1DX-QI) at the 48th Annual International Society for Pediatric and Adolescent Diabetes (ISPAD) Conference! Between October 13-16, 2022, leaders from the T1DX-QI clinics will share one oral and two poster presentations about some of our recent studies.
Learn more about each presentation from the T1DX-QI team at ISPAD 2022:
Disengagement from advanced diabetes technologies during the COVID-19 pandemic associated with worse short-term outcomes in the U.S. T1D Exchange Quality Improvement Collaborative
This study aimed to determine the short-term glycemic outcomes people with type 1 diabetes (T1D) experienced after they discontinued using an insulin pump or CGM between April 1, 2020, and December 31, 2021.
The outcomes we examined were diabetic ketoacidosis (DKA) incidences and A1c for people who stopped using a device, and we compared those outcomes with those from the group who never stopped using a device during that time period. We also separated people into groups based on whether their T1D healthcare appointments during the timeframe were in person or via telehealth.
People who discontinued using a pump or CGM, regardless of in-person or virtual visits:
- Experienced more DKA events after discontinuing device use
- Had higher A1cs after discontinuing device use
For people who stopped using a device and had in-person T1D care visits:
- Instances of DKA increased from 7.6% to 11.1% after discontinuing device use
- Median A1c increased from 8.1% to 8.2% after discontinuing device use
For people who stopped using a device and had telehealth T1D care visits:
- Instances of DKA increased from 11.4% to 13.9% after discontinuing device use
- Median A1c increased from 7.9% to 8.3% after discontinuing device use
Barriers in insulin pump uptake among Hispanics and Black patients with type 1 diabetes: T1D Exchange Multicenter mixed-method study
Multiple studies have shown A1c and insulin pump use are significantly different in patients with T1D between racial and ethnic groups, with lower A1c and higher insulin pump use noted in non-Hispanic white people with T1D compared to Non-Hispanic Black and Hispanic people with T1D.
The T1D Exchange Quality Improvement Collaborative (T1DX-QI) identified six endocrinology centers to pilot an equity-focused study to address disparities in insulin pump use amongst Non-Hispanic Black and Hispanic patients by categorizing barriers into tiers based on how often healthcare providers are seeing these barriers within their practices.
Tier 1 barriers included:
- Difficulty contacting patients for pump classes, visits, and shipment of devices
- Communication to and from pump vendors to clinic/patients
- Insurance issues/denials
- Stringent guidelines/incomplete paperwork for patients on public insurance
Tier 2 barriers included:
- Language barrier/lack of interpreter or materials in other languages
- Provider bias in offering pumps
- Multiple visits/travel costs/missed schoolwork
- Staffing challenges/staff turnover
Tier 3 barriers included:
- Lack of standardized screening tools to assess pump readiness
- Provider concerns about pump safety
- Patient refused/wants nothing attached to their body
- Out of pocket costs for uninsured or underinsured patients
All participating centers reported tier 1 barriers as contributors to inequities. 80% of participating centers identified tier 2 barriers and 40% of participating centers reported tier 3 barriers as contributors to inequities they saw in their clinics.
Impact of the COVID-19 pandemic on disengagement from advanced diabetes technologies among racial/ethnic groups in the U.S. T1D Exchange Quality Improvement Collaborative
The use of continuous glucose monitors (CGMs) and insulin pumps have been associated with improved outcomes in T1D care, so disengaging from these devices represents a risk for worsening health outcomes. The pandemic has presented many self-care challenges for people with T1D, including the continued use of devices like pumps and CGMs.
For this study, we evaluated the effect of the COVID-19 pandemic on device disengagement rates by race and ethnicity.
In other words, how many people stopped using a pump or CGM during the first year of the pandemic, and how does that differ from the number of people who stopped using devices in previous years?
Comparing pre-COVID-19 (January 2017-March 2020) to the first full year of the pandemic in the U.S. (April 2020-2021), we observed the following changes in people with T1D within different racial/ethnic groups who stopped using pumps and CGMs:
- Non-Hispanic White: 3% increase in disengagement
- Hispanic: 7% increase in disengagement
- Non-Hispanic Black: 1% increase in disengagement
Non-Hispanic White and Hispanic people with T1D experienced significant pandemic-related increases in device disengagement. However, although Non-Hispanic Black individuals had no significant pandemic-related increases in disengagement rate, this group has exhibited the highest disengagement rates overall, outside of the study timeframe.