Multi-Clinic Quality Improvement Initiative Increases Continuous Glucose Monitoring Use Among Adolescents and Young Adults With Type 1 Diabetes

Abstract

Continuous glucose monitoring (CGM) use is associated with improved A1C outcomes and quality of life in adolescents and young adults with diabetes; however, CGM uptake is low. This article reports on a quality improvement (QI) initiative of the T1D Exchange Quality Improvement Collaborative to increase CGM use among patients in this age-group. Ten centers participated in developing a key driver diagram and center-specific interventions that resulted in an increase in CGM use from 34 to 55% in adolescents and young adults over 19-22 months. Sites that performed QI tests of change and documented their interventions had the highest increases in CGM uptake, demonstrating that QI methodology and sharing of learnings can increase CGM uptake.

Effect of divergent continuous glucose monitoring technologies on glycaemic control in type 1 diabetes mellitus: A systematic review and meta‐analysis of randomised controlled trials

“…Firstly, uptake of CGM is rapid in the developed world. 52 Secondly, CGM is now frequently integrated into increasingly sophisticated levels of decision support and insulin automation/ closed-loop. This last point, for type 1 diabetes in particular, may begin to make standalone data less relevant (as opposed to Type 2 diabetes where there is an increasing focus on the role of CGM).…”

Feasibility of Electronic Health Record Assessment of 6 Pediatric Type 1 Diabetes Self-management Habits and Their Association With Glycemic Outcomes

“…bias, suboptimal insurance coverage, and high out-of-pocket costs are key structural barriers that must be addressed; the T1DX-QI has already begun some of this work in the areas of CGM and pump adoption. 20,21 Surprisingly, less than 9% of the total clinic population performed all habits, illuminating the fundamental challenge of effective self-management. The biggest opportunities for improvement were the habits related to data review and insulin dose changes.…”

Addressing type 1 diabetes health inequities in the United States: Approaches from the T1D Exchange QI Collaborative

“… 8 T1DX‐QI is a learning health network 9 with over 40 centers across the United States. Participating centers use continuous quality improvement (QI) methods 10 , 11 , 12 and real‐world electronic medical record (EMR) data 4 , 6 for T1D population health improvement.…”

“…The T1DX‐QI has successfully used QI principles and implementation science to improve clinical processes, including increased use of continuous glucose monitors (CGM), insulin pumps, depression screening, improved access to care, and population‐level glycemic outcomes. 9 , 10 , 11 , 12 …”

“…8 T1DX-QI is a learning health network 9 with over 40 centers across the United States. Participating centers use continuous quality improvement (QI) methods [10][11][12] and real-world electronic medical record (EMR) data 4,6 for T1D population health improvement.The T1DX-QI is coordinated by the T1D Exchange, a Boston-based nonprofit coordinating center. The goals of the T1DX-QI were described in a separate commentary.…”