Small steps in clinic boost insulin pump use among youths, young adults
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Insulin pump use increased by 13% among adolescents and young adults with type 1 diabetes at five clinics that developed their own support interventions, according to findings published in Clinical Diabetes.
As part of the T1D Exchange Quality Improvement Collaborative, the clinics developed programs around support for patients starting and continuing insulin pump therapy; education on effective insulin management; and support for patients in active problem-solving for glucose monitoring, insulin management and nutrition education.
“Key interventions included first identifying what patient barriers were to using technology or starting on a pump and identifying patient barriers to bolusing,” Nicole Rioles, MA, director of clinical partnerships and population health at T1D Exchange, told Healio. “The second key intervention was to support patient and family education and empower them as decision-makers and problem-solvers through the process. Other important interventions included reviewing the processes and workflows to time-consuming, multi-set processes, such as facilitating the insurance approval process and supporting patients and families through the onboarding process. As the processes improved and become more effective and efficient, clinics could onboard more patients more quickly.”
Rioles and colleagues analyzed data from the four pediatric endocrinology practices and one adult clinic. Plan-Do-Study-Act cycles were conducted for each center to develop and implement interventions to increase and sustain insulin pump use among adolescents and young adults aged 12 to 26 years with diabetes duration of at least 1 year. The project began in May 2018, and centers began testing interventions by July 2018. Centers reported monthly the number of patients with at least two HbA1c values in the past 12 months and the percentage of those using insulin pumps through February 2020.
In the 6 months before the start of the project, insulin pump use was stable, with a use rate of 45%. During a 22-month study period, mean insulin pump use across the five centers increased to 58% (P < .0001). As part of the findings, researchers included a table with eight interventions for other diabetes centers to implement.
“The eight distinct interventions can be started as small tests of change. A new clinic can start one of those changes tomorrow, just with one clinician in one session, as a mini-pilot that can expand over time,” Rioles said. “We advocate for using structured templates and tools, such as a Plan-Do-Study-Act worksheet. It’s particularly helpful to document and measure processes over time so that improvement can be tracked. The table also shares insights on how clinics implemented the tests of change, using different tactics. There is often more than one solution, and it’s helpful to match an intervention so that it complements clinical needs and capacity/resources.”
Rioles said future research will focus on people most at need, including those with an HbA1c above 9% and people with public health insurance. Addressing racial disparities in diabetes technology use is also a focus for the T1D Exchange Quality Improvement Collaborative.
“We need additional research and data that tracks health outcomes for people with diabetes by race, ethnicity, income and insurance type so that we can set goals to overcome those inequities,” Rioles said.
For more information:
Nicole Rioles, MA, can be reached at nrioles@t1dexchange.org.
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