Quality improvement interventions reduce disparities with CGM use in type 1 diabetes
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Interventions that incorporate shared decision-making, reduce racial-ethnic bias and provide language-specific instruction can reduce disparities with continuous glucose monitoring use in type 1 diabetes, according to two presenters.
In findings presented at the International Conference on Advanced Technologies & Treatments for Diabetes, five clinics participating in the T1D Exchange Quality Improvement Collaborative were able to boost CGM use among patients through a variety of interventions. The largest increases in CGM use were observed among non-Hispanic Black and Hispanic people with type 1 diabetes.
Data were derived from Odugbesan O, et al. ID 679. Presented at: International Conference on Advanced Technologies & Treatments for Diabetes; Feb. 22-25, 2023; Berlin (hybrid meeting).
“The T1D Exchange Quality Improvement Collaborative is a learning health system of 55 diabetes centers,” Osagie Ebekozien, MD, MPH, chief medical officer at T1D Exchange, and Oriyomi Odugbesan, MD, MPH, associate director for quality improvement at T1D Exchange, told Healio. “T1D Exchange Quality Improvement methodology integrates traditional process improvement tools with an equity lens. Our systematic approach is a 10-step framework, easy-to-use process that encourages making small improvements in clinical care practices.”
Two adult endocrinology centers and three pediatric endocrinology centers were recruited to participate in the study. Baseline data were collected from November 2020 to June 2021. Participating centers tested a series of interventions designed to increase CGM use from July 2021 to November 2022. Researchers compared the percentage of patients using CGM during baseline with use rates during the intervention period. Data were stratified by race and ethnicity.
The study included 817 non-Hispanic white people with type 1 diabetes, 235 non-Hispanic Black patients and 111 Hispanic patients. Of the cohort, 69% of white patients used CGM prior to the start of the intervention compared with 51% of Black people and 56% of Hispanic people.
During the intervention period, CGM use increased by 9% for non-Hispanic white people, 13% for Black people and 15% for Hispanic people. The difference in CGM use between white and Black patients was reduced by 4%, and the difference between white and Hispanic patients decreased by 6%.
Researchers identified several interventions that helped increase CGM use, including provider bias training, translation of CGM material to other languages, conducting CGM education in other languages, use of shared decision-making and screening for social determinants of health.
“Centers with strong leadership engagement, a robust culture of quality improvement and those that were able to change major local institutional policies had the most significant improvement,” Ebekozien and Odugbesan said. “Our collaborative efforts improved not just overall CGM use, but more importantly reduced inequities in CGM between people of color with type 1 diabetes as compared to non-Hispanic white people with type 1 diabetes. We are very proud about these results.”
Ebekozien and Odugbesan said more studies to identify new interventions that can further reduce disparities with CGM use should be conducted in the future.
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Odugbesan O, et al. ID 679. Presented at: International Conference on Advanced Technologies & Treatments for Diabetes; Feb. 22-25, 2023; Berlin (hybrid meeting).
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