Introduction & Objective: Clinic-level factors that may influence HbA1c among youth with T1D have not been explored in-depth. We qualitatively investigated differences in practices between diabetes centers reporting mean clinic HbA1c <7% and ≥7%.
Methods: Semi-structured interviews based on the Donabedian model were conducted with endocrinologists, educators, dieticians, social workers, and psychologists at pediatric T1D centers selected from an existing international collaborative to represent diversity in practice. We used the rapid analysis matrix method for deductive consensus coding and thematic analysis.
Results: Thirty-one interviews were conducted at 7 T1D clinics across Australia (n=1), China (n=1), India (n=1), Sweden (n=1) and the United States (n=3) (2019-2023). Key clinic-and provider-level drivers of differences in youth HbA1c were the 1) extent to which education timelines and messaging were standardized and personalized 2) existence of protocols for care coordination and escalation 3) availability of patient and clinic-level data to inform decision-making (Figure 1).
Conclusion: Our exploratory study generates useful hypotheses about clinic-and-provider-level messaging, protocols and resources that may shape youth HbA1c. Further research should evaluate how much these factors influence health and the potential for translation across clinics.
A. Cristello Sarteau: None. N.R. Gopisetty: None. K.J. Souris: None. D. Bowlby: None. N. Jain: None. B.R. King: None. W. Liu: None. F. Malik: None. C. Pihoker: None. C.E. Smart: None. N. Tandon: None. E.J. Mayer-Davis: None.
