Imagine a future where everyone with type 1 diabetes (T1D) has access to targeted, connected care — built on measurable principles and shaped by the collective wisdom of diabetes experts nationwide. By leveraging shared insights and actionable, evidence-based practices, this vision is becoming a reality. 

At the heart of this work is the T1D Exchange Quality Improvement Collaborative (T1DX-QI) Clinical Leadership Committee. Drawing on frontline experience, the committee informs big-picture strategy — setting priorities, refining goals, and identifying new areas of focus across the Collaborative. 

Serving as its strategic compass, the Clinical Leadership Committee analyzes data, identifies trends, and uncovers gaps in care to guide quality improvement efforts. These insights transform strategy into action — enabling clinics to implement solutions more quickly and improve outcomes in real time. 

Today, T1DX-QI brings together pediatric and adult clinical leaders from more than 60 endocrinology centers nationwide. Together, they work toward targeted improvements and greater health equity for people living with diabetes. 

In this way, the Clinical Leadership Committee bridges high-level strategy with real-world change. 

 

Meet our leadership team 

Co-Chairs:  

Francesco Vendrame, MD, PhD, Associate Professor of Medicine, in the Division of Endocrinology, Diabetes, and Metabolism at the University of Miami. 

Carla Demeterco-Berggren, MD, PhD, Clinical Professor of Pediatrics at the University of California, San Diego, and pediatric endocrinologist at Rady Children’s Hospital, San Diego. 

Participation in the Clinical Leadership Committee is structured around primary investigators (PIs) — the designated leaders representing each center, and led by T1DX-QI support staff Nicole Rioles, MA, and Claire Rainey, BA.

 

Leading with purpose  

“The Clinical Leadership Committee is really where ideas turn into action,” said Dr. Vendrame. It brings together clinicians who are deeply involved in day-to-day care and asks a simple but important question: How do we make things better for people living with type 1 diabetes, in a way that actually works in real clinics?” 

Much of the effort begins with identifying gaps — whether in access to technology, workflow inefficiencies, or disparities in outcomes — and then developing practical, scalable solutions. 

“What I appreciate most,” he added, “is that it’s not just about generating data, but about using that data to drive meaningful, measurable change.”  

  

Diverse perspectives, shared purpose 

The committee brings together leaders at every stage of their careers — from division chiefs with decades of experience to early-career physicians stepping into PI roles for the first time. That mix of perspectives creates natural opportunities for mentorship and collaboration. 

“A PI is essentially our point person,” explained Nicole Rioles, Senior Director of Clinical Partnerships and Engagement at T1D Exchange. “They bring ideas back to their teams, build leadership buy-in, and help translate collaborative decisions into action within their own clinics.” 

Pediatric and adult providers often bring different points of view, shaped by the needs of the population they serve. Navigating those differences — and turning them into actionable strategies — is central to the committee’s impact, she said.  

With dozens of leaders participating, structure is essential. Gathering a central voice requires a carefully organized agenda and facilitation. 

“You don’t bring an unanswered question to a group like this,” Rioles explained. “You come with two or three strong options — then the group refines them together.” 

  

From vision to action  

The committee’s impact is perhaps most visible in the initiatives it helps bring to life. 

“One example I am particularly proud of is the effort to elevate early detection of T1D,” said Dr. Demeterco-Berggren. “By advocating for the inclusion of early-stage data in the T1DX-QI database, we helped shift the focus from reactive care at diagnosis to proactive identification and monitoring.” 

That work led to the creation of the T1DX-QI Beta Cell Preservation Working Group, which advanced strategies for screening, staging, and implementing disease-modifying therapies.  

“This work is already helping centers develop programs that delay disease progression and reduce the risk of DKA at diagnosis,” she said. 

What began as a focused initiative quickly expanded into a large, multi-center effort — spanning multiple subgroups and a comprehensive body of work, including a white paper.

Another example is the committee’s prioritization of expanding access to diabetes technologies across the network. This has led to coordinated quality improvement efforts with centers utilizing shared data to identify gaps in access and differences in care.  

“Over time, this has contributed to increased adoption of these technologies,” said Dr. Vendrame. “While disparities still exist, there has also been encouraging progress with targeted efforts.” 

 

Why this work matters 

“This work is deeply meaningful to me because it reflects a shift in how we approach T1D,” said Dr. Demeterco-Berggren, “moving from reacting to clinical disease to anticipating and potentially modifying its course.” 

She recalled a defining moment of beginning to see families identified through early detection programs before any T1D symptoms developed.  

“Being able to offer education, monitoring, and disease-modifying therapy — helping families feel informed and supported, while reducing the risk of severe presentations — reinforces that this work truly matters.”  

For Dr. Vendrame, the connection between system-level change and individual outcomes is equally meaningful. 

“It’s easy to focus on metrics, but behind every data point there is a person managing a complex condition every day,” he said. “I remember a patient who had struggled for years with glycemic variability and felt overwhelmed by the complexity of their care.”  

“After we implemented some of the changes from our QI work, they were able to access new technology — and things finally felt more manageable.” 

 

Improving outcomes at scale 

“The Clinical Leadership Committee plays a central role in guiding quality improvement efforts across the collaborative,” said Dr. Demeterco-Berggren. 

“It brings together multidisciplinary leaders to identify gaps in care, set priorities, and develop scalable, data-driven strategies that can be implemented across diverse clinical settings.” 

The committee serves a forward-looking role — helping to prepare for emerging advances by aligning centers, integrating innovation into practice, and building the infrastructure needed to support change.   

“Through this work, the committee translates evidence and innovation into real-world practice,” she said, “with the goal of improving outcomes, reducing disparities, and ensuring that advances in care reach people living with T1D in a timely and equitable way.” 

  

The pipeline: Looking forward 

Earlier identification, interventions, and a more personalized, data-informed approach are redefining what’s possible in type 1 diabetes care. 

“What I find most exciting is the shift toward more individualized and data-driven care,” said Dr. Vendrame. “With the increasing integration of digital platforms, we’re better able to understand each patient’s unique patterns and tailor treatment more precisely.” 

At the same time, he noted the importance of implementation. “One of the key challenges is ensuring these advances are implemented in a practical, scalable, and accessible way for everyone.” 

Dr. Demeterco-Berggren pointed to the growing potential of early intervention and its potential to preserve beta cell function. “We’re entering an era where screening, staging, and disease-modifying therapies can change the trajectory of T1D,” she said.  

The committee is helping shape this future by building the supportive infrastructure — from integrating early-stage data into registries to promoting equitable access to emerging therapies.  

By aligning centers around these priorities, the Clinical Leadership Committee is helping to accelerate the transition from innovation to standard of care.  

 

Wrapping it up 

As diabetes technology and treatments continue to evolve, so too will the work of the T1DX-QI Clinical Leadership Committee. 

For Rioles, its greatest strength lies in the people behind it.  

“These are clinicians who deeply understand diabetes care,” she said. “When they come together to share ideas, challenge assumptions, and mentor the next generation of leaders, that’s where real progress begins.”