The Impact of Climate Change on People Living with Diabetes: A Scoping Review

Objective: There is substantial literature detailing the interaction between climate change and diabetes incidence, prevalence, and development. However, there is limited understanding on the impact of climate change on People Living with Diabetes (PWD). This scoping review describes the impact of climate change on morbidity and mortality for PWD.Materials and methods: The scoping review was conducted between November 2022 and February 2023, using articles published in PubMed Central and Google Scholar databases. Articles published from 1970 to 2022 with the following key terms “diabetes”, “type 1 diabetes”, “type 2 diabetes”, “climate change”, “global warming”, and “natural disaster” were reviewed. Results: A total of 13,838 articles were identified and reviewed. After applying the review criteria, 42 applicable articles were included in the scoping review. PWD are impacted directly by climate change-induced events including extreme temperatures, air pollution, and natural disasters. Difficulty in storing insulin, maintaining special diets, and accessing diabetes supplies are indirect results of the climate crisis on people with diabetes leading to adverse outcomessuch as increased risk of hospitalizations, morbidity, and mortality. Conclusions: Environmental hazards due to climate change increase morbidity and mortality for PWD. Policies that address the interconnection between the two phenomena would improve global diabetes population health. Future research should explore potential solutions to addressing this crisis across multiple populations and settings

Differences in COVID-19 Outcomes Among Patients With Type 1 Diabetes: First vs Later Surges

Background Outcomes of the novel coronavirus SARS-CoV-2 (COVID-19) have improved throughout the pandemic. However, whether outcomes of COVID-19 in the type 1 diabetes (T1D) population improved over time is unknown. Therefore, we aim to investigate differences in COVID-19 outcomes for patients with T1D in the US. Method We analyzed data collected via a registry of patients with T1D and COVID-19 from 56 sites between April 2020 and January 2021. First, we grouped cases into First Surge (04/09/2020 - 07/31/2020, n=188) and Late Surge (08/01/2020 - 01/31/2021, n=410). Then, we compared outcomes between both groups using descriptive statistics and logistic regression models. Results Adverse outcomes were more frequent during the first surge including Diabetic Ketoacidosis (32% versus 15%, p<0.001), severe hypoglycemia (4% versus 1%, p=0.04) and hospitalization (52% versus 22%, p<0.001). The First surge cases were older (28 +/- 18.8 years versus 18.8 +/- 11.1 years, p<0.001), had higher hemoglobin A1c (HbA1c) levels (Median (IQR): 9.3 (4.0) versus 8.4(2.8), <0.001) and use public insurance (n(%): 107 (57) versus 154 (38), p <0.001). There were five times increased odds of hospitalization for adults (OR 5.01 (2.11,12.63) in the first surge compared to the late surge. Conclusion COVID-19 cases among patients with T1D reported during the first surge had a higher proportion of adverse outcomes than those presented in a later surge

971-P: Use of Telemedicine for Type 1 Diabetes Care in the T1D Exchange Quality Improvement Collaborative (T1DX-QI) in 2021

Background: The COVID-pandemic accelerated adoption of telemedicine for diabetes care in 2020. We sought to describe the utilization of telemedicine across the T1DX-QI in 2021. Methods: Twenty four pediatric and nine adult clinics completed a survey about the proportion of televisits performed, center goals and processes in fall of 2021. Results: The majority of clinics reported performing between 11-25% (n=16, 48%) and 0-10% televisits (n=9, 27%) . The majority reported a pre-visit preparation workflow (n=24, 73%) , but most sites reported not having a staff member dedicated to supporting televisits (n=21, 64%) . No major differences in televisit use, goals, and processes were observed between pediatric and adult sites. For diabetes technology data downloads, the majority of clinics integrated data automatically into the EHR (n=25, 73%) . The major barriers to sustaining telemedicine practice across clinics were patient internet access, patient health disparities and access to device data (Figure 1) . Conclusion: More than one year into the pandemic the proportion of televisits performed by the T1DX-QI collaborative is modest. Clinic workflows have been implemented to support telemedicine but insufficient institutional support and technology barriers still represent an obstacle

Current Practices in Operationalizing and Addressing Racial Equity in the Provision of Type 1 Diabetes Care: Insights from the T1DX-QI Health Equity Advancement Lab

OBJECTIVEMedical racism contributes to adverse health outcomes. T1DX-QI is a large population-based cohort engaged in data sharing and quality improvement to drive system changes in type 1 diabetes care. The annual T1DX-QI survey included questions to evaluate racial equity in diabetes care and practices to promote equity. METHODSThe annual T1DX-QI survey was administered to participating clinics fall 2022 and had a 93% response rate. There were 50 responses (pediatric-66%, adult-34%). Questions, in part, evaluated clinic resources and racial equity. Response data were aggregated, summarized and stratified by pediatric/adult institutions. RESULTSOnly 21% pediatric and 35% adult institutions felt all their team members can articulate how medical racism contributes to adverse diabetes outcomes. Pediatric institutions reported more strategies to address medical racism than adult (3.6 vs 3.1). Organizational strategies to decrease racial discrimination included employee trainings, DEI offices/committees, patient resources and hiring practices. Patient resources include interpreter services, transportation, insurance navigation, and housing and food assistance. Hiring practices included changing prior protocols, hiring from the community, and diversifying workforces. Majority of institutions have offered anti-racism training in the last year (pediatric-85%, adult-72%) and annually (pediatric-64%, adult-56%). Pediatric teams felt that their anti-racism training was effective more often (pediatric-60%, adult-45%) and more commonly were provided resources (pediatric-67%, adult-47%) to help address inequities. CONCLUSIONDespite increased offering in anti-racism training, insufficient institutional support and perceived subeffective training still represent obstacles especially in adult institutions. Sharing effective strategies to address medical racism will help institutions take steps to mitigate inequities

1023-P: Current Practices in Racial Equity—Findings from the T1D Exchange Quality Improvement Collaborative (T1DX-QI) in 2022

Background: Medical racism contributes to adverse health outcomes. T1DX-QI is a large population-based cohort engaged in data sharing and quality improvement to drive system changes in type 1 diabetes care. The annual T1DX-QI survey included questions to evaluate racial equity in diabetes care and practices to promote equity. Methods: The annual T1DX-QI survey was administered to participating clinics fall 2022 and had a 94 % response rate. There were 50 responses consisting of 66% pediatric (P) and 34% adult (A) institutions. Questions concerned clinic resources, LGBTQ+ practices, racial equity, patient transition, and reproductive health. Response data were aggregated, summarized and stratified by P/A institutions. Results: Only 21% P and 33% A institutions felt all their team members can articulate how medical racism contributes to adverse diabetes outcomes. Pediatric institutions reported more strategies to address medical racism than adult (3.6 vs 3.1). Organizational strategies to decrease racial discrimination included employee trainings, DEI offices/committees, patient resources and hiring practices. Patient resources include interpreter services, transportation, insurance navigation, and housing and food assistance. Hiring practices included changing prior protocols, hiring from the community, and diversifying workforces. Majority of institutions have offered anti-racism training in the last year (P 85%, A 72%) and annually (P 64%, A 56%). Pediatric teams felt that their anti-racism training was effective more often (P 60%, A 45%) and more commonly were provided resources (67% P vs 47% A) to help address inequities. Conclusion: Despite increased offering in anti-racism training, insufficient institutional support and perceived subeffective training still represent obstacles especially in adult institutions. Sharing effective strategies to address medical racism will help institutions take steps to mitigate inequities. Disclosure J.Sanchez: None. M.Zupa: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. T1dx-qi collaborative: n/a. J.Cases-villablanca: None. A.Addala: None. A.Mungmode: None. T.Wright: None. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc. A.Ahmann: Advisory Panel; Medtronic. N.N.Mathioudakis: None. J.Ng: Research Support; Sanofi-Aventis U.S. Funding The Leona M. and Harry B. Helmsley Charitable Trus

<b>Increasing Continuous Glucose Monitoring Use for Non-Hispanic Black and Hispanic People With Type 1 Diabetes: Results From the T1D Exchange Quality Improvement Collaborative Equity Study</b>

Despite the benefits of continuous glucose monitoring (CGM), there is lower use of this technology among Non-Hispanic Black and Hispanic people with type 1 diabetes compared to their non-Hispanic White counterparts. The T1D Exchange Quality Improvement Collaborative recruited five endocrinology centers to pilot an equity-focused quality improvement (QI) study to reduce racial inequities in CGM use. The centers used rapid QI cycles to test and expand interventions such as provider bias training, translation of CGM materials, provision of CGM education in multiple languages, screening for social determinants of health, and shared decision-making. After implementation of these interventions, median CGM use increased by 7% in non-Hispanic White, 12% in non-Hispanic Black, and 15% in Hispanic people with type 1 diabetes. The gap between non-Hispanic White and non-Hispanic Black patients decreased by 5%, and the gap between non-Hispanic White and Hispanic patients decreased by 8%.</p

Making Diabetes Electronic Medical Record Data Actionable: Promoting Benchmarking and Population Health Improvement Using the T1D Exchange Quality Improvement Portal

   This article describes how the T1D Exchange Quality Improvement Collaborative leverages an innovative web platform, the QI Portal, to gather and store electronic medical record (EMR) data to promote benchmarking and population health improvement in a type 1 diabetes learning health system. The authors explain the value of the QI Portal, the process for mapping center-level data from EMRs using standardized data specifications, and the QI Portal’s unique features for advancing population health.</p