As Frustrations Mount, T1D Exchange Tackles Problems in Diabetes Care

diabetes clinic wait times

It is clear that many people living with or loving someone with type 1 diabetes (T1D) are frustrated — not only with the challenges of managing their diabetes day-to-day, but also with insurance coverage and costs, access to high quality medical care and compassionate support by their care team.

In 2014, the American Diabetes Association published new recommended HbA1c guidelines: a 7.5% target blood glucose levels for individuals less than 18 years of age and 7.0 % for adults (there are different targets for pregnancy, complex health, and poor health).

In the T1D community, we appreciate that there is a great deal of sensitivity around numbers, especially HbA1c. One of our goals has been to better understand what average HbA1c looks like in the real-world—the people living with type 1 diabetes every day. We know from our T1D Exchange Clinic Registry data that most people aren’t meeting the recommended target goals1.


HbA1c quality diabetes clinic care


At T1D Exchange, we are committed to not only reporting on outcomes like HbA1c, but we are also dedicated to:

  • understanding problems that limit better outcomes and quality of life, and
  • investing in new solutions that will reduce the burden of managing T1D and create meaningful change.

To this end, we have launched a new Quality Improvement Initiative.

What’s Quality Improvement (QI)?

Quality Improvement is the combined and unceasing efforts of everyone—people living with T1D and their families, healthcare professionals, researchers, payers, planners, and educators—all working together to make changes that will lead to better patient outcomes (health), better system performance (care) and better professional development.

In short, the Quality Improvement initiative is bringing together a collaborative team to tackle the challenges of today’s care environment and improve it for people living with T1D, their families, and our clinical partners.

What are the goals of the T1D QI Initiative?

This past year, the QI team has been primarily focused on uniting key stakeholders who will work together in 2017 to:

  • Create a collaborative network of dedicated clinics seeking to improve care;
  • Establish clinical and patient leaders and teams, and develop QI initiatives;
  • Establish a Learning Commons as a way to collect and share learnings, build consensus and support the collaborative activities;
  • Facilitate shared learning and QI training to improve care along the way;
  • Develop and test new approaches for patient/clinician interaction, care processes, interventions and methods of measuring outcomes such as patient satisfaction and quality of life; and
  • Build technology processes and infrastructure to support data capture, reporting and analyses to better understand the needs of patients and drive better health outcomes.

Over the past several months, our collaborative community and ten founding clinics have been working together to understand factors that influence a patient’s health and diabetes outcomes. We know that there are many health and life factors that negatively impact outcomes. Therefore our group is working closely with patients and families as part of this learning collaborative. We’re learning a lot about patient frustration and their desire to be heard and considered part of the care team. We’ve also heard that a lot of time gets lost between a patient and a provider going over medication refills and reviewing lab requirements, leaving less time for the patient to talk with their provider about pressing concerns.

The QI Initiative is a big part of the most important work we will do over the next several years, and we look forward to keeping the community up-to-date on our progress and how you can get involved.

Dana Ball
Co-founder and Executive Director
T1D Exchange

  1. T1D Exchange Clinic Registry Data “Average Current HbA1c by Age.” Data through 8/1/16; n = 20,868


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