Establishment of a Clinical Quality Improvement Program for Type 2 Diabetes by the T1D Exchange QI Collaborative

Implementing best practice guidelines for diabetes and cardiovascular comorbidities is important to reduce the risk of complications for people with type 2 diabetes. The T1D Exchange Quality Improvement Collaborative (T1DX-QI) established a type 2 diabetes quality improvement (T2D-QI) program to reduce cardiovascular risk for people with type 2 diabetes by improving glucose, blood pressure, and lipid management initiation. The program began in 2019 with an adult endocrine center in the Northeast and a primary care center on the West Coast. In 2023, a new equity-focused type 2 diabetes intervention began with 3 adult endocrine centers on the East Coast, with an aim to increase access to and use of continuous glucose monitors. In 2023, 4 primary care centers focused on improving screening measures for adults with type 2 diabetes, prioritizing glycated hemoglobin A1_c, blood pressure, lipid, and urine albumin-to-creatinine ratio. Each clinic received training in quality improvement (QI) methodology and coaching from QI consultants to develop initiatives tailored to the needs of their clinics. Lessons gathered through qualitative interviews and reports included the importance of training the clinical team in QI methodology; adopting lower effort, higher impact interventions to build momentum and cultivate confidence and engagement among clinical teams; obtaining timely data updates; and engaging partners who could champion the work, influence practice, and navigate system complexities. The expansion of T1DX-QI to include type 2 diabetes demonstrated that standardized QI training and interventions developed through a data-driven iterative process and delivered through multidisciplinary teams can be successful.