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T1D Exchange was honored to join top scientists, providers, and industry experts in the diabetes space from June 21-24 at the American Diabetes Association’s® (ADA) 84th Scientific Sessions, presenting groundbreaking scientific research.
The T1D Exchange Quality Improvement team members in attendance presented five oral and nine poster presentations, including a Scholars Session: “Does Quality Improvement Impact Outcomes for People with Diabetes?” by Osagie Ebekozien, MD, MPH, CPHQ. Dr. Ebekozien is the Chief Medical Officer at T1D Exchange and lead for the T1D Exchange Quality Improvement Collaborative (T1DX-QI).
Two symposium sessions were held, “Improving Diabetes Outcomes and Reducing Inequities Through Collaboration: Perspective from the T1D Exchange” and “Current Approaches to Addressing Racial Equity—Insights from the T1D Exchange QI Collaborative.”
Below, we have highlighted T1D Exchange research and findings, reinforcing our mission to improve outcomes for the entire type 1 diabetes (T1D) population by driving real-world evidence and collaborative change.
T1D Exchange Quality Improvement Oral Presentations:
329-OR: Dynamics of Treatment Regimens and Glycemic Outcomes in >100,000 Children from International Pediatrics Diabetes Registries
The American Diabetes Association has recognized this abstract as an ADA Presidents’ Select Abstract.
Over the past decade, advances in T1D management have led to time-in-range improvements in the pediatric T1D population. This study compared treatments and glycemic outcomes in children (≥18 years with T1D ≥ 3 months) from 8 diabetes registries and the SWEET initiative from 2013 to 2022.
Data was examined from over 100,000 children in the National Registry and over 35,000 children in the Sweet initiative. Researchers investigated demographics, A1C results, insulin delivery devices, diabetes ketoacidosis (DKA) rates, and severe hypoglycemia episodes for each registry.
Study highlights include:
- A1C improvements across all registries (66,4 mmol/mol in 2013 to 59.3 mmol/mol in 2022)
- Insulin pump use increases in all registries (42.9% in 2013 to 62.2% in 2022)
- DKA and severe hypoglycemia rates decrease
Although diabetes technology use has increased significantly over the past decade, there were notable differences in its use across the registries in this study.
136-OR: Examining New-Onset Type 1 Diabetes Educational Practices among Centers in the T1D Exchange Quality Improvement Collaborative (T1DX-QI)
Receiving targeted and timely education is crucial for disease management for those newly diagnosed with T1D and their caregivers. With this in mind, researchers sought to examine the current state of education delivery through a survey administered to 55 diabetes centers involved with the T1DX-QI.
Study results highlighted the following:
- T1DX-QI centers most commonly offer four educational sessions (42%)
- Daily communication is the most common cadence immediately following T1D diagnosis (33%)
- Phone calls are the most common communication modality used (77%)
- Pediatric centers most frequently offer a meal to teach carb-counting skills (85%), while adult centers do not
Across the 50 centers that completed the survey (91% completion rate), education practices were non-standardized and exhibited wide variations. This study suggests that further research is needed to determine best practices for education post-T1D diagnosis.
T1D Exchange Quality Improvement Poster Presentations:
778-P: Changes in HbA1c with GLP-1 Use in People with Type 1 Diabetes: Data from the T1D Exchange QI Initiative
Despite the lack of approval for glucagon-like peptide 1 receptor agonists (GLP-1RA) in people living with T1D, many individuals in this population are using them. However, there is limited data regarding its safety and efficacy in T1D. This study aimed to examine the effect of its use on body weight and A1C results in people living with T1D.
EMR data from 13 T1DX-QI clinics was obtained. The study examined data from 481 individuals living with T1D who were prescribed a GLP-1RA.
Findings showed:
- A mean reduction in A1C results from 7.5% to 7.3% (after 6-12 months of using a GLP-1RA)
- No significant measurable difference in BMI or DKA events in those taking a GLP-1RA
This study suggests clarifying the use, optimal dosing, and secondary benefits of prescribed GLP-1RA medications, such as decreasing the risk of comorbid cardiovascular disease.
804-P: Understanding Off-Label Use of GLP (Glucagon-Like Peptide-1 Receptor) Agonists among Providers Participating in the T1D Exchange Quality Improvement Collaborative (T1DX-QI)
The use of glucagon-like peptide-1 agonists (GLP-1a) as an additional T1D therapy continues to be explored. From July to September 2023, 55 T1DX-QI centers were surveyed about their opinions and use of GLP-1a in people with T1D.
With 91% of centers completing the survey, this study found that 50% of pediatric and 75% of adult centers believe that GLP-1a therapy has a role in T1D management as an adjunctive medication. They also reported that they would consider adding a GLP-1a to insulin therapy, considering BMI and total daily insulin use.
The study uncovered that insurance is often seen as a barrier in pediatric and adult groups, even when considering BMI.
In addition, adult providers were more likely to prescribe GLP-1a medications for individuals with a family or personal history of nonalcoholic fatty liver disease and/or atherosclerotic cardiovascular disease or for those who have a desire to lose weight.
959-P: Multiple Daily Injection (MDI) to Automated Insulin Delivery (AID) Versus non-AID Insulin Pump for Newly Diagnosed People with Type 1 Diabetes Offers Improvement in Glycemic Control
We often see in clinical trials that people who use AID systems benefit from lower A1C values. However, real-world evidence in people with T1D is lacking. This observational crossover study utilized EMR data of newly diagnosed individuals between 2019 and 2023 from 32 T1DX-QI centers.
Researchers compared two groups: those who started on MDI at diagnosis and switched to an AID system (2.3 years on average) versus those who switched to a non-AID system (1.2 years on average). A1C levels were then compared between groups.
Results varied from group to group:
- MDI to AID system decreased from 7.7% to 7.4%
- MDI to a non-AID system decreased from 8.0% to 7.9%
Overall, the MDI to AID system group experienced a greater decrease in A1C levels and fewer episodes of severe hypoglycemia.
1109-P: Diabetes Technology Education Processes Among Centers in the T1D Exchange Quality Improvement Collaborative (T1DX-QI)
This study described prescribing and educational practices and processes for diabetes-related technologies. From July to September 2023, a survey was administered to 55 T1DX-QI centers with a 91% completion rate.
Survey results showed:
- Endocrinologists are most likely to be a CGM prescriber
- CGM is most frequently prescribed at diagnosis
- Medical assistants most often handle prior authorizations
- Diabetes educators most often provide CGM education
For all diabetes technology (CGM, insulin pumps, automated insulin delivery devices, and smart insulin pens), 93% of centers provide outpatient education by clinic staff once the individual has the device. In addition, the study found that diabetes technology training is not standardized, and there are variations between pediatric and adult diabetes centers.
1118-P: Engaging Data Teams in Electronic Medical Record Data Extraction for Diabetes Real World Data and Improvement Projects
While data in an electronic medical record (EMR) is incredibly valuable, data extraction for research is difficult on many levels. This study sought perspectives about common challenges from 18 T1DX-QI diabetes centers.
There was an 82% response rate (18 out of the 22 centers participating in the study), with more than half (61%) of these teams conducting at least 6 data extraction projects each year. Almost half (45%) of centers reported the same effort for diabetes data extraction as other disease areas. Finally, most (73%) centers reported an efficient T1DX-QI data mapping experience.
The most frequently identified errors were readily addressed in iterative review cycles and by initiating a checklist for best practices. This study concluded that data extraction is a feasible and achievable process for both quality improvement and population health purposes.
1131-P: Successful Strategies to Reduce Delays in Quality Data Reporting
Collecting quality diabetes data and benchmarking between hospital systems comes with its challenges, namely unstandardized operability in EMRs.
T1DX-QI centers undergo comprehensive data mapping processes for QI and population health analysis. Between 2018 and 2020, this process took 20 months to complete on average. In 2021, the T1DX-QI took steps to decrease this time frame.
With new strategies implemented (expanded data integration services plus staff resources and cross-training, project management services, and resources), mapping times decreased from 20 to 13 months.
By supporting T1DX-QI centers, this study highlights the ability to expedite data collection and mapping, improving processes and quality of diabetes care and outcomes.
1293-P: Real-World Status of Autoantibody Screening and Teplizumab Administration Readiness Among Centers Participating in the T1D Exchange Quality Improvement Collaborative (T1DX-QI)
Autoantibody screening has gained more interest since November 2022, when Teplizumab, an injectable medication to delay the onset of T1D, received FDA approval.
This study aimed to understand the real-world readiness for screening and the ensuing administration of Teplizumab for those found to be at risk. From July to September 2023, the study was administered to the 55 participating T1DX-QI centers.
With a 91% completion rate (50 of 55 centers), the study found that 68% of centers had not made significant changes to their screening processes. Of those that made changes, they only adjusted protocols for screening first-degree relatives of those with T1D.
Moreover, findings suggested that pediatric centers were more prepared to administer Teplizumab than adult centers.
1456-P: Type 1 Diabetes Care and Device Use in Older Adults: Transatlantic Comparison Based on T1DX-QI and DPV Registries
Research suggests that CGM, insulin pump, and AID system use can improve time spent in target range and overall quality of life with T1D. However, there was a data gap in older adults (≥60 years old).
This study aimed to understand CGM, insulin pump, and AID system use in this population and their glycemic outcomes by examining data from the T1DX-QI (median age 67.5) and the Diabetes Patients Follow-up or DPV (median age 68.9) Registry in 2022.
Findings showed:
- CGM use was similar (50.3% in T1DX-QI vs. 47.9% in DPV)
- Insulin pump use was about two times higher (40.7% in T1DX-QI vs. 17% in DPV)
- AID use was about three times higher (20.4% in T1DX-QI vs. 6.4% in DPV)
- A1C average was lower (7.1% in T1DX-QI vs. 7.4% in DPV)
1939-LB: Improving Capacity for Quality Improvement in Type 2 Diabetes Primary Care Centers
Many primary healthcare centers (PHCs) caring for people with type 2 diabetes (T2D) operate on shoestring budgets in addition to being overwhelmed by other constraints.
The goal of this study was to support operational changes that allowed for the implementation of evidence-based quality improvement (QI) projects for this population.
Four centers were recruited for this QI project by the American Diabetes Association (ADA), with T1D Exchange mentoring on QI and change management from August 2023 to March 2024. Selected QI metrics for the T2D pilot included A1C testing, monitoring for kidney health, and statin use. The PHCs utilized PDSA cycles, with providers reporting aggregate monthly data for the almost 8,000 individuals serviced who live with T2D.
Of the three centers completing the pilot, there was an overall improvement in QI capacity, with each noting improvements in at least one outcome measure.
Participating centers gleaned individual benefits such as a 7% increase in statin prescriptions, while another, a 14% increase in A1C screenings.
This study suggests that QI coaching and external support can help to activate effective, measurable changes.
