TY - JOUR
T1 - Targeting Technology in Underserved Adults With Type 1 Diabetes
T2 - Effect of Diabetes Practice Transformations on Improving Equity in CGM Prescribing Behaviors
AU - Mathias, Priyanka
AU - Mahali, Lakshmi Priyanka
AU - Agarwal, Shivani
N1 - Funding Information:
Acknowledgments. The authors thank the diabetes providers, clinical/support staff, leadership (Y. Tomer, J. Crandall, E. Epstein), and the patient advisors at the Fleischer Institute for Diabetes and Metabolism at MMC, for their role in this study. Funding. Financial support for this study was provided by the National Institute of Diabetes and Digestive Kidney Diseases (5K23-DK115896, P30DK111022) for the senior author’s time.
Funding Information:
The authors thank the diabetes providers, clinical/support staff, leadership (Y. Tomer, J. Crandall, E. Epstein), and the patient advisors at the Fleischer Institute for Diabetes and Metabolism at MMC, for their role in this study.
Publisher Copyright:
© 2022 by the American Diabetes Association.
PY - 2022/10
Y1 - 2022/10
N2 - OBJECTIVE Continuous glucose monitoring (CGM) is associated with improved outcomes in type 1 diabetes, but racial-ethnic disparities exist in use. We were interested in examining whether addressing structural health care barriers would change provider prescribing behaviors to make CGM access more equitable. RESEARCH DESIGN AND METHODS From January 2019 to December 2021, we used multilevel stakeholder input to develop and implement several non-grant-funded practice transformations tar-geted toward equity, which included 1) developing a type 1 diabetes clinic, 2) conducting social needs assessments and management, 3) training support staff to place trial CGMs at the point of care, 4) optimizing prescription workflows, and 5) educating providers on CGM. Transformations were prioritized based on feasibility, acceptability, and sustainability. To examine effect on prescribing be-haviors, we collected monthly aggregate data from the electronic medical record and performed multiple linear regression to examine and compare change in CGM prescriptions over the 3 years of transformation. RESULTS In total, we included 1,357 adults with type 1 diabetes in the analysis (mean ± SD age 38 ± 18 years; 30% Black [n = 406], 45% Hispanic [n = 612], 12% White [n = 164]; and 74% publicly insured [n = 1,004]). During the period of transformation, CGM prescription rates increased overall from 15% to 69% (P < 0.001). Improvements were seen equally among Black (12% to 72%), Hispanic (15% to 74%), and White adults (20% to 48%) (between-group P = 0.053). CONCLUSIONS Diabetes practice transformations that target equity, offload provider burdens, and focus on feasible sustainable stakeholder-driven solutions can have powerful effects on provider prescribing behaviors to reduce root causes of inequity in CGM among underserved adults with type 1 diabetes. Continued focus is needed on upstream de-terminants of downstream CGM use.
AB - OBJECTIVE Continuous glucose monitoring (CGM) is associated with improved outcomes in type 1 diabetes, but racial-ethnic disparities exist in use. We were interested in examining whether addressing structural health care barriers would change provider prescribing behaviors to make CGM access more equitable. RESEARCH DESIGN AND METHODS From January 2019 to December 2021, we used multilevel stakeholder input to develop and implement several non-grant-funded practice transformations tar-geted toward equity, which included 1) developing a type 1 diabetes clinic, 2) conducting social needs assessments and management, 3) training support staff to place trial CGMs at the point of care, 4) optimizing prescription workflows, and 5) educating providers on CGM. Transformations were prioritized based on feasibility, acceptability, and sustainability. To examine effect on prescribing be-haviors, we collected monthly aggregate data from the electronic medical record and performed multiple linear regression to examine and compare change in CGM prescriptions over the 3 years of transformation. RESULTS In total, we included 1,357 adults with type 1 diabetes in the analysis (mean ± SD age 38 ± 18 years; 30% Black [n = 406], 45% Hispanic [n = 612], 12% White [n = 164]; and 74% publicly insured [n = 1,004]). During the period of transformation, CGM prescription rates increased overall from 15% to 69% (P < 0.001). Improvements were seen equally among Black (12% to 72%), Hispanic (15% to 74%), and White adults (20% to 48%) (between-group P = 0.053). CONCLUSIONS Diabetes practice transformations that target equity, offload provider burdens, and focus on feasible sustainable stakeholder-driven solutions can have powerful effects on provider prescribing behaviors to reduce root causes of inequity in CGM among underserved adults with type 1 diabetes. Continued focus is needed on upstream de-terminants of downstream CGM use.
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U2 - 10.2337/dc22-0555
DO - 10.2337/dc22-0555
M3 - Article
C2 - 36054022
AN - SCOPUS:85139375186
SN - 0149-5992
VL - 45
SP - 2231
EP - 2237
JO - Diabetes care
JF - Diabetes care
IS - 10
ER -
