T1D Exchange Quality Improvement Collaborative: A Learning Health System to Improve Outcomes for All People With Type 1 Diabetes

Medical advances, including the development of new medications and advanced technologies, have the potential to improve outcomes for youths and adults with type 1 diabetes, but that potential has not yet been fully realized, particularly in minority groups and those with low socioeconomic status (SES). The report by Majidi et al. in this issue (1) adds to the growing literature exposing racial and ethnic inequities in type 1 diabetes. These data, derived from a mostly young cohort (76% <26 years of age), show that non-Hispanic Blacks experienced higher rates of diabetic ketoacidosis (DKA), higher A1C levels, and lower use of technology compared with non-Hispanic Whites. Non-Hispanic Black patients with type 1 diabetes who are hospitalized with coronavirus disease 2019 are also more likely to present in DKA (2). There is a crucial need to address barriers to care and provide resources to overcome unjust and avoidable health disparities that persist within nondominant racial and ethnic groups (3). Understanding and addressing these barriers can be achieved by understanding our current state and implementing interventions to decrease barriers and improve outcomes. In 2016, the T1D Exchange established the T1D Exchange Quality Improvement Collaborative (T1DX-QI). This collaborative started with 10 pilot sites, which were primarily well-respected, academic pediatric diabetes centers. Its initial focus was on children and adolescents/emerging adults with type 1 diabetes, the group who has the highest A1C levels (4,5). Since then, the T1DX-QI has continued to expand, now encompassing 30 centers across the United States (Figure 1), and is beginning to direct attention to adults as well as youths with type 1 diabetes. Participating centers strive to improve care delivery and health outcomes and reduce barriers to care for everyone with type 1 diabetes by sharing best practices and data benchmarking (6). FIGURE 1 Geographical distribution of T1DX-QI sites. …