1 INTRODUCTION

The T1D Exchange Quality Improvement Collaborative (T1DX-QI), established in 2016, aims to refine best practices, emphasize quality of care, and improve diabetes outcomes across the country in those with type 1 diabetes (T1D).¹ T1DX-QI includes over 55 diabetes centers, including both adult and pediatric diabetes centers, allowing it to investigate and improve diabetes care for over 85 000 people. Over the past 7 years, it has been on the forefront of collaborative care and using real-world data to improve diabetes care and outcomes.

The network has had a positive impact on the community, as it continues to bring together centers to support real-world improvement and outcomes, achieving great results. Figure 1 shows the impact of the T1DX-QI group in 2023. The November 2023 conference, similar to previous years, encompasses a wide range of topics in diabetes care and practice improvement, with a focus on psychosocial aspects of care and improving technology advancement and access.

Behavioral health abstracts included screening of eating disorders² and anxiety.³ Gillis et al³ looked at how anxiety affects hemoglobin A1C (A1C) across T1DX-QI sites and found a greater percentage with anxiety have an A1C >9% and that females more than males have elevated anxiety levels. Adams et al⁴ and Weinstock et al⁵ focused on implementation and outcomes of social determinants of health (SDOH) screening in pediatric and adult diabetes centers. Weinstock et al⁵ found those who screened positive were more likely Black and had more than one need to be addressed. The highest need identified on SDOH screening was food insecurity. Ruiz et al⁶ implemented food insecurity screening in their diabetes center and successfully increased the percentage of patients who were screened and received resources.

Several abstracts focused on identifying barriers to technology use and improving use in T1D, particularly technology uptake and equity. In terms of smart insulin pens (SIP), Miyazaki et al⁷ found poor uptake related to copay requirement, lack of samples, and poor responsiveness when trainer reached out to families. Figueredo et al⁸ found significant barriers to patients saving and sharing SIP data, which affects providers ability to make management decisions. Regarding uptake and initiation of continuous glucose monitors (CGM), Milosavljevic et al⁹ found Hispanic race-ethnicity has the lowest CGM prescription rate in their center. Meanwhile, Perkins et al¹⁰ created an electronic medical record tool to track CGM uptake from initial prescribing through obtaining and receiving education on CGM in order to centralize and more closely monitor patients actually obtaining and starting the device. Several diabetes centers focused on increasing insulin pump uptake and use. Miyazaki et al¹¹ found that by reducing stricter requirements for insulin dose optimization prior to discussion of starting an insulin pump, patients with public insurance were 5.6 times as likely to initiate an insulin pump. Ogburn et al¹² focused on decreasing time to insulin pump start and found that virtual pump class or phone follow-up led to shorter time to insulin pump start. Smego et al¹³ found that a pump introduction self-learning packet and virtual pump classes resulted in an increase in insulin pump starts. Coppedge et al¹⁴ focused on improving use of hybrid closed loop systems (HCLS) by increasing education on HCLS and having clinic staff transition patients to HCLS, resulting in overall clinic time in range increase and A1C improvement. Focusing on health disparities,^{15, 16} Jones et al¹⁵ implemented several targeted strategies to decrease disparities and improve CGM use. Their multifaceted approach resulted in significant increases in CGM use in the Black population and in those with public insurance, with associated decreases in A1C levels. Cymbaluk et al¹⁶ also implemented a multifaceted approach to decrease disparities in insulin pump use and found a subsequent increase of 12% in those with public insurance utilizing an insulin pump.

Remote patient monitoring (RPM), the use of connected electronic tools to record medical data that are then reviewed remotely by a provider, has become of greater interest since the increase in telemedicine use during the COVID-19 pandemic. RPM was the focus of two clinics' efforts to improve diabetes care.^17-19 Petty et al¹⁷ found that 73.3% of patients with A1C ≥9% participating in RPM between visits had an improvement in A1C levels, with a median change of −1.0%. DeSalvo et al¹⁸ implemented an RPM program both in newly diagnosed and established patients who are at moderate-to-high risk for diabetes ketoacidosis. Improvement has been seen in self-management habits.¹⁹

With the approval of teplizumab-mzwv, there has been greater interest and need for clinical protocols around early staging and monitoring of T1D. To this end, Simmons et al²⁰ demonstrate identification of early T1D patients and implementation of a clinic focused on those with early stages of T1D.

中文翻译：

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T1D交换质量改进协作学习会议2023年11月摘要评论

1 简介

T1D 交换质量改进合作组织 (T1DX-QI) 成立于 2016 年，旨在完善全国 1 型糖尿病 (T1D) 患者的最佳实践、强调护理质量并改善糖尿病结局。¹ T1DX-QI 包括超过 55 个糖尿病中心，包括成人和儿童糖尿病中心，使其能够调查和改善超过 85 000 人的糖尿病护理。在过去的 7 年里，它一直处于协作护理的最前沿，并利用真实世界的数据来改善糖尿病护理和结果。

该网络对社区产生了积极影响，因为它继续将各个中心聚集在一起，支持现实世界的改进和成果，取得了巨大的成果。图 1 显示了 T1DX-QI 小组在 2023 年的影响。2023 年 11 月的会议与往年类似，涵盖了糖尿病护理和实践改进方面的广泛主题，重点是护理的心理社会方面以及改进技术进步和使用权。

行为健康摘要包括筛查饮食失调²和焦虑。³ Gillis 等人³研究了焦虑如何影响 T1DX-QI 站点的糖化血红蛋白 (A1C)，发现 A1C >9% 的焦虑症患者比例更高，而且女性比男性焦虑水平更高。Adams 等人⁴和 Weinstock 等人⁵重点关注儿科和成人糖尿病中心健康社会决定因素 (SDOH) 筛查的实施和结果。Weinstock 等人⁵发现那些筛查结果呈阳性的人更有可能是黑人，并且需要解决的问题不止一个。SDOH 筛查发现的最高需求是粮食不安全。Ruiz 等人⁶在其糖尿病中心实施了食品不安全筛查，并成功提高了接受筛查和获得资源的患者比例。

一些摘要侧重于确定技术使用的障碍并改善 T1D 的使用，特别是技术的采用和公平。在智能胰岛素笔 (SIP) 方面，Miyazaki 等人⁷发现，由于自付费用要求、样本缺乏以及培训师与家庭接触时反应不佳，采用率较低。Figueredo 等人⁸发现患者保存和共享 SIP 数据存在重大障碍，这影响了提供者做出管理决策的能力。关于连续血糖监测仪 (CGM) 的使用和启动，Milosavljevic 等人⁹发现西班牙裔种族在其中心的 CGM 处方率最低。同时，Perkins 等人¹⁰创建了一个电子病历工具，用于跟踪从最初处方到获得和接受 CGM 教育的 CGM 吸收情况，以便集中和更密切地监控实际获得和启动该设备的患者。一些糖尿病中心致力于增加胰岛素泵的摄取和使用。Miyazaki 等人¹¹发现，通过在讨论启动胰岛素泵之前减少对胰岛素剂量优化的更严格要求，拥有公共保险的患者启动胰岛素泵的可能性提高了 5.6 倍。Ogburn 等人¹²专注于缩短胰岛素泵启动时间，发现虚拟泵课程或电话随访可缩短胰岛素泵启动时间。Smego 等人¹³发现泵介绍自学包和虚拟泵课程导致胰岛素泵启动次数增加。Coppedge 等人¹⁴致力于通过加强 HCLS 教育以及让临床工作人员将患者过渡到 HCLS 来改善混合闭环系统 (HCLS) 的使用，从而导致总体临床时间范围增加和 A1C 改善。关注健康差异，^{15, 16} Jones 等人¹⁵实施了几项有针对性的策略，以减少差异并改善 CGM 的使用。他们的多方面方法导致黑人和公共保险人群中连续血糖监测 (CGM) 的使用显着增加，同时 A1C 水平也随之下降。Cymbaluk 等人¹⁶还实施了多方面的方法来减少胰岛素泵使用的差异，并发现使用胰岛素泵的公共保险的人数随后增加了 12%。

自 COVID-19 大流行期间远程医疗使用增加以来，远程患者监护 (RPM) 是一种使用联网电子工具记录医疗数据，然后由提供商远程审查的技术，已变得越来越受关注。RPM 是两家诊所改善糖尿病护理工作的重点。^17-19 Petty 等人¹⁷发现，在就诊期间参加 RPM 的 A1C ≥9% 的患者中，73.3% 的 A1C 水平有所改善，中位变化为 -1.0%。DeSalvo 等人¹⁸对新诊断和患有糖尿病酮症酸中毒中高风险的患者实施了 RPM 计划。自我管理习惯有所改善。¹⁹

随着 teplizumab-mzwv 的批准，人们对围绕 T1D 早期分期和监测的临床方案产生了更大的兴趣和需求。为此，Simmons 等人²⁰展示了早期 T1D 患者的识别以及针对早期 T1D 患者的诊所的实施。