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

INTRODUCTION

Approximately 1.6 million people in the United States have type 1 diabetes (T1D).¹ The incidence of T1D is increasing in the United States across all populations, most significantly among Hispanic and non-Hispanic Black (NHB) patients.^2, 3 Unfortunately, widespread inequities exist in health outcomes among patients with T1D in the United States.^4–7

In 2016, the T1D Exchange Quality Improvement Collaborative (T1DX-QI) was established.⁸ T1DX-QI is a learning health network⁹ with over 40 centers across the United States. Participating centers use continuous quality improvement (QI) methods^10–12 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.¹³

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.^9–12

In 2020, the T1DX-QI established its health equity program to address inequities systematically and comprehensively in T1D outcomes.¹⁴ This commentary describes practical approaches being employed by the T1DX-QI to address health inequities. These approaches can be valuable examples for diabetes researchers and providers interested in addressing health inequities (Figure 1).

https://onlinelibrary.wiley.com/doi/10.1111/1753-0407.13235