Team Based Pediatric Type 1 Diabetes Care in the US: Current Practices and Sustainability Concerns

Multidisciplinary care can improve glycemic outcomes in individuals with type 1 diabetes (T1D). Yet, prior studies suggest limited utilization of team-based care and either no reimbursement or inadequate reimbursement for diabetes and nutritional education, mental health and social support as well as remote services. We sought to evaluate multidisciplinary care services offered by pediatric diabetes centers to understand whether current practices are sustainable. The Pediatric Endocrine Society Diabetes Special Interest Group collaborated with the T1DX- Quality Improvement Collaborative to survey US pediatric diabetes centers on care delivery practices and resources for new onset and ongoing care, introduction of technology and telehealth focusing on team-based approaches. We analyzed responses from 31 centers, mostly academic, from 16 states and Washington DC representing all geographical regions providing care for 45,759 youth with T1D who had at least one visit in 2022. Most centers (74%) provided initial diabetes education in the inpatient setting using clinic-employed staff. The majority initiated CGMs at or close to diagnosis and offered insulin pump therapy within the first year. All but one center encouraged communication with diabetes teams between visits. Less than half of practices estimated that at least 50% of their youth with T1D received mental health services and assessments for social concerns annually. Telehealth was utilized by all centers. Many centers indicated suboptimal reimbursement, and 87% operated at a budget deficit. Despite the commitment of pediatric diabetes centers to provide high quality multidisciplinary care, many youth with T1D may not receive the services as frequently as recommended. These services are often unreimbursed. We advocate for alternative reimbursement models for clinical workflows that support the delivery of individualized, multidisciplinary care aligned with best practices shown to improve clinical outcomes and quality of life for youth with T1D. Examples include expansion of telemedicine and remote monitoring, non-face-to-face acute and routine care, navigation of technology, supplies and services, engagement and coordination of community-based resources among others. Such models would promote equitable, needs-based care while enabling centers to operate efficiently.