Implementation and Evaluation of a Best Practice Advisory to Reduce Inequities in Technology Use for People with Type 1 Diabetes: Protocol for a Mixed Methods and Non-Randomized Controlled Trial (Preprint)
Authors: Mathioudakis Nestoras , Wolf Risa , Choudhary Abha , Davis Georgia , Gallagher Mary Pat , Gupta Meenal , Kamboj Mammohan , Rioles Nicole , Ospelt Emma , Thapa Susan , Weinstock Ruth S. , Wright Trevon , Ebekozien Osagie 
Published: January 2025

BACKGROUND

Continuous advancements in diabetes technologies have improved self-management for people with type 1 diabetes (PwT1D). Continuous glucose monitors (CGM) and automated insulin delivery (AID) systems have enhanced quality of life and glycemic outcomes while reducing severe hypoglycemia and diabetes ketoacidosis (DKA) hospitalizations. Despite these benefits, racial inequities in the use of advanced diabetes technology (ADT) persist.

OBJECTIVE

This study titled “Best Practice Advisories to Reduce Inequities in Technology Use” (BPA-TECH) aims to develop and evaluate a best practice advisories (BPA) within the electronic medical record (EMR) to reduce racial and ethnic disparities in ADT use. We hypothesize that an EMR-based BPA designed to standardize the prescribing of ADTs will minimize racial and ethnic disparities in ADT adoption or progression in use among pediatric and adult PwT1D.

METHODS

The BPA-TECH study will use a non-randomized matched pair-intervention design. Phase 1 will use qualitative methods to develop and refine the BPA, including focus groups and surveys of healthcare providers and PwT1D or their caregivers. Phase 2 will evaluate the effectiveness of the BPA through a controlled before-after study of PwT1D seen at seven T1D Exchange Quality Improvement Collaborative (T1DX-QI) centers, with control PwT1D matched from non-intervention T1DX-QI centers. The baseline and post-intervention periods will be the 12 months before and 12 months after deployment of the BPA at the intervention centers, respectively. Eligibility criteria include PwT1D aged ≥2 years with an EMR diagnosis of T1D for at least 6 months during the baseline period. The primary outcome is the progression in ADT use from the baseline to post-intervention periods.

RESULTS

This 3-year study began in July 2024. Data collection from key stakeholders for the Phase 1 qualitative research began in August 2024. For Phase 2, we estimate approximately 3,000 eligible non-Hispanic Black and Hispanic PwT1D at intervention centers and 15,000 matched controls. A 15% progression in ADT use is projected based on prior T1DX-QI data. Data on ADT use, A1C, severe hypoglycemic events, and DKA events will be collected via the T1DX-QI coordinating center. We anticipate completion of this study by May 2027.

CONCLUSIONS

The BPA-TECH study aims to leverage health information technology to address racial and ethnic disparities in ADT use among PwT1D. By standardizing the approach to ADT prescribing for PwT1D, the BPA-TECH has the potential to promote equity in diabetes management and improve clinical outcomes. The outcomes of this study will inform future efforts to reduce healthcare disparities.

CLINICALTRIAL

ClinicalTrials.gov NCT 98752815