Ebekozien, O, Maahs, D, Lyons, S, Rompicherla, S, Mungmode, A, Herrick, C, Levy, C, Alonso, G.T, Rapaport, R
Background and Aims: In the last decade, there have been major innovations in the clinical management for people with type 1 diabetes (PwT1D). We analyzed trends in glycemic outcomes and diabetes technologies use stratified by age, insurance, and race‐ethnicity across the T1D Exchange Quality Improvement (T1DX‐QI) multi‐center collaborative.
Methods: T1DX‐QI is a quality improvement learning network of electronic medical record data sharing diabetes centers in the U.S. The analysis cohort includes all PwT1D receiving care in nine adult and twenty‐four pediatric centers from the T1DX‐QI. We examined data for the same PwT1D from 2016 to 2023 using descriptive analysis and logistic regression models.
Results: We included data for 81,455 PwT1D in this cohort. Mean HbA1c was lower in 2022‐2023 than 2016‐2017 (8.1% vs 8.8%, p < 0.01; Figure 1A). However, these improvements were not equally distributed across all racial‐ethnic groups, hence highlighting lack of equity (Figure 1B). There was an absolute increase in the proportion of PwT1D using a continuous glucose monitor, insulin pump, or automated insulin delivery system by 59%, 17%, and 35%, respectively. Significant Insurance and racial‐ethnic disparities in diabetes technology use were observed across the time period. The absolute increases in technology, differences by race‐ethnicicty and insurance were all statistically significant with P < 0.01.
Conclusions: There was substantial improvement in HbA1c and diabetes technologies use for PwT1D from 2016–2023 in the T1DX‐QI cohort, although the magnitude of change differed by race/ethnicity and insurance types. There is a need for large scale studies to test innovative strategies for equitable improvement in outcomes for PwT1D.
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