Introduction: Young children with T1D have unpredictable eating habits, which lead to post-meal insulin administration and resultant hyperglycemia. We designed a quality improvement (QI) project to promote pre-meal bolusing in young children (≤ 6 years old) with T1D.
Methods: A series of bundled Plan-Do-Study-Act (PDSA) cycles were implemented over a 1-yr period from Oct 2022-Sep 2023, including: a. Development of EMR-based parental questionnaire to assess pre-meal bolus behaviors b. Creation of a run chart in QlikView analytics platform to assess real-time progress at the population level c. Development of family-facing educational resources with strategies to enable consistent pre-meal bolusing d. Tailored education for pre-meal bolusing delivered by CDCES and RD in clinic and telemedicine encounters e. Efforts to expand CGM and automated insulin delivery system use in young children f. Psychology support for parents with fear of hypoglycemia and/or diabetes distress
Results: The rate of pre-bolusing increased by 36% over a 1-yr period from a baseline of 50% in Oct 2022 to 86% in Sep 2023 (Figure 1).
Conclusion: This QI intervention led to an increase in pre-meal bolusing in young children with T1D, which may have direct clinical benefit in optimizing glycemic outcomes (e.g., HbA1c and time-in-range). Figure 1: Control chart indicating rate of pre-meal bolusing in children ≤ 6 years
K.A. Hicks: None. E.N.P. Macaluso: None. S.R. Kelly: None. S. Uysal: None. D. DeSalvo: Advisory Panel; Insulet Corporation. Consultant; Dexcom, Inc.
