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Improvement in equity of CGM prescriptions after targeted interventions

Background/Objective: Continuous glucose monitoring (CGM) use is associated with improved outcomes in type 1 diabetes, but racial-ethnic disparities in use exist. We initiated targeted interventions to improve CGM prescriptions in our medical center among racial-ethnic minority populations and examined rates over time.

Methods: From January 2019 to August 2021, we developed a specialty clinic for type 1 diabetes, expanded provider awareness of inequity and training in CGM, and improved prescribing workflows. As a participating site of the T1D Exchange Quality Improvement Collaborative (T1DX-QI), we collected monthly aggregate data over the intervention period using the electronic medical record. We calculated CGM prescription rates with the numerator representing number of people prescribed CGM in the reporting month and the denominator representing number of total patients seen by endocrinology in the same month. We performed ANOVA testing to examine differences by race-ethnicity over time.

Results: In total, 880 patients were included. The majority of participants were publicly insured (71%): 42% Hispanic, 30% non-Hispanic Black, and 13% non-Hispanic White. Overall, CGM prescription rates significantly increased from 51% to 70% (P < .05). The largest improvement in rates occurred in non-Hispanic Black from 52% to 80% with equal changes for Hispanic (53 to 68%) and White (53 to 67%) (P < .001). Conclusions: Targeted clinical interventions that focus on CGM equity awareness, staff training, and workflow efficiency can substantially increase CGM prescription rates in underserved populations with type 1 diabetes. Participating in the T1DX-QI will allow for shared learning of our success and focus on translation to continued use.
T1DX-QI

T1DX-QI

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