Introduction and Objective: Patients with diabetes and intellectual, developmental, and physical disabilities (IDPD) often have worse glycemic control and greater complications but may be overlooked when prescribing diabetes technology. This project aimed to increase insulin technology prescriptions at an academic center by 15% in patients with diabetes and IDPD over one year using a physician toolkit.Methods: An Epic-based registry identified patients with diabetes with intellectual or developmental disabilities, or visual/hearing impairment. A toolkit was developed including insulin technology overviews and guidance on prescribing and adapting devices for individual use. The toolkit provided considerations for each commercially available automated pump, sensor, insulin patch, and smart pen addressing visual, tactile, audio and cognitive factors. Dedicated outreach was conducted on the patients in the registry to evaluate them for insulin technology.Results: There were 49 patients identified (mean age 59 years, BMI 29.2, 53% male). Diabetes types included type 2 (74%), type 1 (22%), and steroid-induced (4%) with mean HbA1c 8.6. Complications included nephropathy (78%), neuropathy (59%), retinopathy (53%), and macrovascular disease (41%). Baseline CGM and insulin pump use were 59% and 2%, respectively. Post intervention, there was a 41% increase in prescriptions including 12 sensors, 4 pumps, 2 smart pens, and 2 insulin patches. Pumps were prescribed to visually impaired patients, smart pens to patients with nonverbal autism and Down syndrome respectively, and insulin patches to patients with visual or hearing impairment. Among patients prescribed sensors, underlying conditions included developmental delay (2), Turner syndrome (1), autism (2), Fragile X syndrome (1), ADHD (1), and hearing or visual impairment (4).Conclusion: A targeted physician toolkit increased diabetes technology prescribing and improved access for underserved patients with IDPD. Longer term follow-up is needed to assess effects on glycemic control and complications.
R. Maini: None. G. O’Malley: Research Support; Ended; Dexcom, Inc. Research Support; Current; Abbott, MannKind Corporation. C.J. Levy: Research Support; Current; Tandem Diabetes Care, Inc., Novo Nordisk, Abbott Diabetes, MannKind Corporation. Consultant; Current; MannKind Corporation, Tandem Diabetes Care, Inc. Research Support; Current; Deka/Sequel, Dexcom, Inc., Genti Bio. Consultant; Current; Deka/Sequel.
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