Optimizing Glycemic Outcomes for Children with Type 1 Diabetes

Despite technological advances that have enhanced the capability to optimize glycemic management, many children with T1D are unable to meet the recommendations because of a multitude of barriers in SDOH, education, technology access, and psychosocial support. This has led to quality improvement initiatives such as the T1DX-QI, which focuses on areas such as care delivery, self -management, and psychosocial support.55,56 One initiative increased CGM use in 12 to 26 -year -old patients with T1D from 34% to 55% during 19 to 22 months using interventions such as coaching patients, training clinical teams, and provider engagement in advocacy efforts to promote CGM coverage by their state's Medicaid program.57 Another initiative increased insulin pump adoption in 12 to 26 -year -old patients with T1D by 13% by increasing inperson and telehealth technology education and improving clinic staff knowledge.58 Although continued efforts are needed to develop processes that improve T1D care for all patients, emphasis needs to be placed on initiatives that eliminate racial, ethnic, and socioeconomic disparities.59,60 Strategies are also needed to ensure equitable availability of insulin and technologies. Achieving target blood glucose levels in children with T1D requires addressing the medical and psychosocial aspects of T1D. Additional quality improvement study is needed to reduce gaps in care delivery, psychosocial support, and health equity, such that diabetes care and quality of life can be improved for all children with T1D.