October 16, 2025

T1D Exchange (T1DX) Health Equity Advancement Lab (HEAL) Meeting:

October 16, 2025, 1-2 pm ET, Zoom

Participants:

Jenise Wong, Colette, Carla Demeterco, Ananta Addala, Janine Sanchez, Anyanate Gwendolyne Jack, Selorm Dei- Tutu, Shideh Majidi, Ashley Butler, Nicole Rioles, Trevon Wright

Agenda:

Time	Item	Facilitator
1:00-1:05 pm 05’	Welcome Welcome	Dr. Dei-Tutu   Dr. Butler
1:05-1:25 pm 20’	Manuscript Overview	Dr. Dei-Tutu Dr. Butler; All
1:25-1:35 pm 10’	Updates on Health Equity	Dr. Butler;
1:35:-1:55 pm 20’	Brainstorm/share any new or current Equity Initiatives	Dr. Dei-Tutu Dr. Butler; All
1:55-2:00 pm 5’	Updates and Close-Out Summary of next steps Next meeting: Thursday January 23, 2025;  1-2pm EST	T1DX-QI staff

Manuscript Discussion

• A poster was presented at a past ADA conference (2025) using survey data to examine the diversity of center staff and patients with diabetes.
• Findings indicated a higher proportion of people with type 2 diabetes identified as a minoritized race or ethnicity compared to those with type 1.
• Most pediatric centers reported a greater percentage of patients with type 2 diabetes were from minoritized groups, but over 80% of centers reported less than 50% of their staff identified as from a minoritized race or ethnic group.
• 90% of centers responded to the survey, including 38 pediatric centers and 18 adult centers.
• The poster concluded there is a mismatch in the racial and ethnic composition of staff and patients, especially for those with type 2 diabetes in pediatric settings.
• A recommendation was made for QI efforts to assess how this discordance affects patient experiences and outcomes, and to explore strategies to diversify the workforce.
• Determine if there’s an association between the racial demographics of patients with type 1 diabetes (separated by adults and pediatrics) and the racial demographics of the diabetes center staff.
• Examine information about patient outcomes to see if there’s an association with the proportion of minoritized staff and overall patient outcomes.

Manuscript Writing Group

• There are plans to use more recent survey data than what was presented in the poster.
• Dei-Tutu and Dr. Butler will send an email to those interested in working on the manuscript and meet as a manuscript writing group to figure out next steps for writing up the results.
• Butler and Dr. Dei-Tutu submitted a data request for that information.
• A manuscript about concordance was written recently and can be sent over for review. It summarizes where concordance matters and how it impacts diabetes outcomes.
• There is interest in the level of detail in the data, especially regarding workforce representation in different staff roles (nurses, social workers, RDs).

Smaller Workforce and Health Outcomes

• Smaller physician ratios adversely impact health outcomes.
• Budget cuts in healthcare disproportionately affect rural areas with smaller workforces.
• Policy relevance: Maintaining workforce and funding in areas at a tipping point is crucial.
• The question of whether a smaller workforce is associated with differential outcomes has policy relevance, especially with funding for hospitals being pulled.

Data Collection Concerns (annual survey)

• Concern about self-reported data from providers or staff.
• Each clinic provides one response for the entire practice.
• Survey asks for both enterprise-wide and endocrine/diabetes clinic-specific data.
• Institutions may have restrictions on asking these type of questions.

Food Insecurity Screening Project-Dr. Butler

• Project: Implemented validated food insecurity screening (hunger vital sign) for youth with type 1 diabetes at Texas Children’s Diabetes Care Center.
• Screening completion rate: Nearly 90% of youth with established diabetes (duration of at least one year or longer) were screened between early 2022 and end of 2022.
• Hunger vital sign: Two items; endorsement of one or both triggers offering resources like written materials on food assistance programs.
• Feasibility: Screening is feasible, even with sensitive topics like food insecurity.
• Opportunity: Develop and evaluate a robust intervention to address food insecurity, beyond standard resource provision, in partnership with a community-based organization.

Project Intervention and Team

• The intervention involves refining an existing intervention for a food-insecure population.
• The team includes: A member from the Children’s Nutrition Center at Texas Children’s with expertise in diet and healthy eating interventions.
• Lyons, a PEDs Endo investigator and Jasmine from the Houston Food Bank, who is a co-investigator.
• Tanya Nil (consultant): Previously worked on healthy eating and type 1 diabetes, developed an intervention that can be refined for this project.
• Deborah Ellis (consultant): A psychologist who can help adapt the intervention for delivery by a community health worker.
• The intervention will combine Tanya’s family-based behavioral intervention around healthy eating with the FoodRx program from the Houston Food Bank.
• FoodRx is a food prescription program that provides access to a wider range of food options for individuals with chronic health conditions.
• The project aims to develop and refine an intervention to improve outcomes for families with type 1 diabetes who are food insecure.

Community Health Worker

• The initial funding from Helmsley allowed for the integration of screening and a second round of funding to bring on a community health worker.
• The community health worker’s role is not limited to food insecurity but includes helping families with various needs such as finding beds, applying for housing, and college applications.
• The speaker hopes that the same community health worker can be brought on board for this project.
• The speaker notes that the lack of positive screens was due to issues with training, rollout, and MA workload.

Implementation of Food Insecurity Screening at Rady

• Rady implemented food insecurity screening in EPIC a few years ago.
• Initially, a paper form was used, but many families felt uncomfortable discussing food insecurity.
• MAs felt uncomfortable asking the questions and required wellness training.
• The screening was moved to an electronic format with the question of whether the family wants to discuss it.
• Positive screens trigger a referral to a specialist.

Screening for Social Drivers at UCSF

• UCSF screened for food and transportation insecurity using paper-based methods, achieving 60-70% screening rates.
• Food insecurity was found in approximately 25% of type 1 and type 2 diabetes patients, while transportation issues affected 10-15%.
• Due to staffing constraints, UCSF transitioned to tablet-based screening via Epic’s “Welcome” tablet and MyChart.
• This change reduced the ability to offer social worker follow-up, which was previously valued by families.

Next Steps and Collaborative Opportunities

• The next meeting will feature a presentation from one of the participants about their initiative.
• Participants are encouraged to think about potential collaborative projects and ideas.
• There is a discussion about coordinating with T1DX-QI and HEAL to explore special projects or funding opportunities with an equity perspective.

Meeting Recording: https://us02web.zoom.us/rec/share/WP4CV-qd2fTVqttSTc9tutOcJg8Q39ihy9ZnN3Zg06eq6Pf9TWEFlpwcgqrjJVsN.1uGgG5AdtLbFcl5n?from=hub

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