Current Practices in Operationalizing and Addressing Racial Equity in the Provision of Type 1 Diabetes Care: Insights from the T1DX-QI Health Equity Advancement Lab

Medical racism contributes to adverse health outcomes. T1DX-QI is a large population-based cohort engaged in data sharing and quality improvement to drive system changes in type 1 diabetes care. The annual T1DX-QI survey included questions to evaluate racial equity in diabetes care and practices to promote equity.

The annual T1DX-QI survey was administered to participating clinics fall 2022 and had a 93% response rate. There were 50 responses (pediatric-66%, adult-34%). Questions, in part, evaluated clinic resources and racial equity. Response data were aggregated, summarized and stratified by pediatric/adult institutions.

Only 21% pediatric and 35% adult institutions felt all their team members can articulate how medical racism contributes to adverse diabetes outcomes. Pediatric institutions reported more strategies to address medical racism than adult (3.6 vs 3.1). Organizational strategies to decrease racial discrimination included employee trainings, DEI offices/committees, patient resources and hiring practices. Patient resources include interpreter services, transportation, insurance navigation, and housing and food assistance. Hiring practices included changing prior protocols, hiring from the community, and diversifying workforces. Majority of institutions have offered anti-racism training in the last year (pediatric-85%, adult-72%) and annually (pediatric-64%, adult-56%). Pediatric teams felt that their anti-racism training was effective more often (pediatric-60%, adult-45%) and more commonly were provided resources (pediatric-67%, adult-47%) to help address inequities.

Despite increased offering in anti-racism training, insufficient institutional support and perceived subeffective training still represent obstacles especially in adult institutions. Sharing effective strategies to address medical racism will help institutions take steps to mitigate inequities.