August 16, 2024

Diabetes Screening, August 16, 2024
Meeting minutes

Meeting Slides

Attendees: Trevon Wright, Osagie Ebekozien, Alex Tuttle, Nicole Rioles, Emma Ospelt, G.
Calderon, Lydia Holly, Shideh Majidi, Lauren Culbreth, Laura Jacobsen, Don Buckingham,
Daniel DeSalvo, Kelly Timmons, Carla Demeterco, Mary McCauley,

• Review of Aim statement and project timeline
  • Increase by 15% people screened by 12/2025
  • Increase by 3% people monitored for progression to stage 3 T1D
  • Timeline: report to Smartsheet; attend meetings; use PICK tool for
    prioritization; start PDSAs in Sept.
• Reporting data
  •  Lurie Children’s still needs to start Smartsheet reporting
• Fishbone diagrams
  • Texas Children’s: barriers to successful screening; go live at end of month;
    counseling for screening. Concerns about insurance coverage, financial
    burdens, education; webinar for PCPc- teach how to screen and stage. Edu
    at faculty and fellow meetings. Cost barriers for teplizumab.
  • Challenges for monitoring: CGM not covered if insulin is not already
    prescribed. Providers try to give samples. Area for advocacy. Some centers
    just using glucometer now.
  •  Lurie: Education barriers. Families may not be aware of screening options.
    teplizumab-mzwv: info for families. Double booking is a barrier; registration
    in epic: trying to see siblings screening, ideally creating an appt for them.
    Shared patient list in epic. Barriers to insurance coverage. Using samples.
    Enable kits in clinic started in August: $20 co-pay. Out of pocket: $90. Order
    screening in house to see results. ASK kits are similar to TrialNet. Enable
    easier- less stressful.
  • Children’s National: Inconsistencies, policies, procedures. Trying to make a
    clear process. Trying to optimize in Cerner. Adding to new onset binders.
    Trying to build access for CGMs. Trying to cover cost issues for all pieces.
    Leveraging social work support, language translations. Hope to be adding
    admin support for visits; lack of provider knowledge; lunch and learns;
    framing equity issues; patient knowledge; limited education support.
  • Indiana: Insurance coverage screening; self-referrals vs direct referral from
    provider is murky; early stage clinic: spots limited: focusing monitoring on
    stage 1 and 2. Educating PCPs who are referring patients. Overall lack of
    educational materials; patient facing materials are being promoted; trying to
    standardize; need to consider CGM; telehealth limitations; lack of care kits
    for POC; variation among clinics. Looking to make uniformity in the same
    level of care across practices; phlebotomist available at once monthly clinic
    for staging; education for team members and how to handle positive
    screens; how to handle questions for people not on until yet; family
    awareness and education; standardized visuals; TrialNet site; challenge with
    access during weekends. Enable bio kits being used (when they are
    available.)
  • Rady has materials in multiple language and is willing to share
• Review of preliminary results
  • Smartsheet data results 157 screened, 92 positive- majority stage 3.
  • Mean age: 11
  • 75% white
  • 58% privately insured
  • Majority confirmed autoantibodies: 91%
  • 100% have scheduled follow up with Endo
  • A1c: 5.5%. No documented DKA
  • 83% offered, 23% accepted teplizumab
  • Feedback: High positivity rate: can we identify whether first or second degree
    relatives in Smartsheet?
• Next meeting: send 3-5 interventions to test;