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Diabetes Mellitus, Type 1NCT06931275

Best Practice Advisories to Reduce Inequities in Technology Use for People With Type 1 Diabetes

A study testing EMR-based BPA model in people with Diabetes Mellitus, Type 1, run by T1D Exchange, United States at 2 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The overall goal of the study is to create a standardized, stakeholder-informed system within EMRs, that will enable an equitable and regular prescription and documentation of advanced diabetes technologies. This will reduce racial disparities and generate an understanding of the reasons behind prescription decisions. Read more about this study

Who is it for?
Ages 2 to 95 yearsHealthy volunteers can take part
Conditions the study is for
Diabetes Mellitus, Type 1
What is being tested?
EMR-based BPA model
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
1,178 participants
Where
2 sitesUnited States
Study dates
13 Aug 2024to 30 Jul 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 2 to 95 years
  • All sexes
  • Healthy volunteers accepted
  • Child, Adult, Older adult

Who may be able to join

  • non-Hispanic Black and Hispanic individuals

Who cannot join

  • PwT1D with evidence of use of AID at baseline

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Osagie Ebekozien, MD contact

857-205-2388

oebekozein@t1dexchange.org

Trevon Wright, MHA contact

6178927564

twright@t1dexchange.org

United States2 sites, 2 recruiting
  • T1D Exchange

    Boston, Massachusetts, 02110

    Osagie Ebekozien, MPH, MD, 857-205-2388, oebekozien@t1dexchange.org

    Trevon Wright, MHA, 617-892-7564, twright@t1dexchange.org

    Recruiting
  • T1D Exchange

    Boston, Massachusetts, 02111

    Osagie Ebekozien, MD, 8572052388, oebekozien@t1dexchange.org

    Trevon Wright, MHA, 2569497029, twright@t1dexchange.org

    Not yet recruiting

Other trials in United States

About this study

Official title: Implementing Best Practice Advisories to Reduce Inequities in Technology Use for People With Type 1 Diabetes

The overall goal of the study is to create a standardized, stakeholder-informed system within EMRs, that will enable an equitable and regular prescription and documentation of advanced diabetes technologies. This will reduce racial disparities and generate an understanding of the reasons behind prescription decisions.

The study will highlight the development and implementation an EMR-based Best Practice Advisory (BPA).

The study will answer whether the EMR-based BPA can effectively reduce disparities. Additionally, it will explore why providers may not prescribe advanced diabetes technologies.

Patients will also be surveyed to understand their perspectives on developing the EMR-based BPA.

Read the detailed description

For the proposed study we intend to implement an automatically delivered center decision support system provided at the time and location of the decision making along with actionable recommendations and computer based actionable recommendations. The provider will be required to opt out if not prescribing ADT and to provide a reason for not prescribing in order to advance on the EMR screen (Kawamoto et al, 2015).

Project Objectives Aim 1: To develop and implement an EMR-based BPA using stakeholder feedback to standardize the approach for prescribing and documentation of advanced diabetes technologies (ADT) (CGM, insulin pump, AID) among adult and pediatric PwT1D.

Aim 2: To determine the effectiveness of an EMR-based BPA in reducing racial inequities in ADT.

Primary Objective: To compare the proportion of non-white (non-Hispanic Black and Hispanic) PwT1D with progression in ADT use (CGM, insulin pump, AID) at 6 centers in the T1DX-QI (3 pediatric and 3 adult centers) where the BPA intervention is implemented with matched control non-white PwT1D at T1DX-QI centers not receiving the intervention over a 12-month period, adjusting for baseline level of ADT use and other confounders.

Secondary Objective: To assess the difference in ADT use between White and non-white (non-Hispanic Black and Hispanic) PwT1D receiving care at the intervention centers compared with the racial difference in ADT use in matched control PwT1D.

Aim 3: To explore the reasons identified for providers decision to not prescribe ADT and whether they were patient or provider led, and the association between the reason provided and the patient's race/ethnicity.

Methodology Overview Focus group discussions and structured interviews will be conducted among adult and pediatric endocrine providers based on the Agency for Healthcare Research and Quality (AHRQ) "Five Rights" (Flores et al, 2019) which engenders effective clinical decision support. Also other guiding frameworks such as the T1d Exchange Health Equity Framework (Ebekozien et al, 2019) will guide this process. The BPA as well as the approach to be followed for the documenting discussions between the provider and patients will be refined by the results of the qualitative study.

Using a non-randomized matched-pair intervention design, we will compare ADT use following a BPA intervention among non-Hispanic Black and Hispanic PwT1D receiving care at 6 T1DX-QI centers with matched control non-Hispanic Black and Hispanic PwT1D receiving care at a non-intervention center over a 12-month period.

Six T1DX-QI centers that are data mapped to the T1DX-QI database by study initiation will be selected for the intervention centers. There will be four additional centers as possible back-up if one or more of the 6 anticipated centers are not able to participate. Matched "control" PwT1D will also be selected from centers with mapped data.

Primary Outcome Definition: Primary outcome: Progression in ADT use (as documented in EMR) during the 12-month study period. The primary outcome would be defined as positive for an individual if any of the following occurs:

  • No CGM à Any CGM
  • MDI à Insulin pump
  • No AID à AID

Based on this definition, a PwT1D in any of the following technology transition states would be considered as meeting the primary endpoint:

  • MDI/smartpen + no CGM begins using CGM
  • MDI/smartpen + CGM begins using insulin pump
  • Insulin pump + no CGM begins using CGM
  • Insulin pump + CGM (without AID) begins using AID

Data Analysis for Aim2 Primary: Progression in ADT use in the intervention group compared with matched-pair controls adjusting for number of encounters, correlation of matched pairs, and random center effects.

Secondary: Analysis will mimic the primary analysis for adjustment of confounders.

  • Progression in AID use in the intervention group compared with matched pair controls
  • Progression in CGM use in the intervention group compared with matched pair controls
  • Progression in Insulin Pump use in the intervention group compared with matched pair controls
  • Change in the proportional difference in CGM use between white and non-white individuals (non-Hispanic black and/or Hispanic) in the intervention group compared with matched pair controls.
  • Change in the proportional difference in insulin Pump use between white and non-white individuals (non-Hispanic black and/or Hispanic) in the intervention group compared with matched pair controls
  • Change in HbA1c (lab result closest to end date of period) from baseline in the intervention group compared with matched pair controls Exploratory: Analysis will mimic the primary analysis for adjustment of confounders.
  • Change in proportion of sustained ADT Use in in the intervention group compared with matched pair controls. Sustained use defined as at least two consecutive EMR records with ADT use documented during the post period.

We will explore if the reasons technologies are not recommended/accepted differ by race and other factors. This aim is exploratory, and the extent of the analysis will ultimately depend on information collected as part of the BPA developed during Aim 1. If patient race is associated with differences in rates of technology prescribing/use, these findings will inform further interventions to address the contributing causes.

Being tested
EMR-based BPA model, Placebo (EMR-based without BPA model)
Keywords
Advanced Diabetes Technologies,, Automated Insulin Delivery, Best Practice Advisories, Continuous Glucose Monitoring.
Medical subject headings
Diabetes Mellitus, Type 1

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • EMR-based BPA modelOther

    Advanced Diabetes Technologies including AIDs, insulin pumps and CGMs will be prescribed to patients after an EMR-based BPA implementation at six centers.

  • Placebo (EMR-based without BPA model)Behavioural

    Advanced Diabetes Technologies including AIDs, insulin pumps and CGMs will be prescribed to patients after an EMR-based system without BPA at the implementation at six centers.

Study groups in NCT06931275
Study groupRoleWhat they receive
ADT use following Best Practice Advisory among non- Hispanic Black and Hispanic Patients with T1DExperimentalADT use following a BPA intervention among non-Hispanic Black and Hispanic PwT1D receiving care at 6 T1DX-QI centers will be assessed. The EMR-based BPA will be designed to recommend ADT prescription to patients not already using some type of ADT using a rule-based algorithm. ADT will include CGM, insulin pumps, and AID systems. We will work with each of the 6 centers to implement the BPA as part of the Epic EMR. The function will generate a BPA if patient is not utilizing a CGM or pump/AID. If the patient is not on a CGM, pump or AID system (if already using CGM and pump), the BPA will suggest discussing and/or prescribing CGM (or pump/AID) to the provider. The provider will answer in the affirmative or say, "not discussed" or "patient declined." If the provider chooses to opt out of prescribing, they will be forced to provide a reason for not prescribing to advance the screen. Providers in each intervention center will be trained on the BPA process prior to implementation.
Receives: Other: EMR-based BPA model
ADT use among non- Hispanic Black and Hispanic Patients with T1DPlacebo comparatorThe arm will comprise of a matched control non-Hispanic Black and Hispanic PwT1D receiving care at a center over a 12-month period. Participants will be matched on the basis of Age categories, biological sex, Insurance status, Area deprivation index, Baseline Technology use, Duration of T1D bins, and Baseline HbA1c.
Receives: Behavioral: Placebo (EMR-based without BPA model)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Progression of Advanced Diabetes Technology use

    Defined as positive for an individual if: • MDI/smartpen + no CGM begins using CGM

    • MDI/smartpen + CGM begins using insulin pump
    • Insulin pump + no CGM begins using CGM
    • Insulin pump + CGM (without AID) begins using AID

    Measured: 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Apr 2025
  2. Study start13 Aug 2024
  3. Primary completion30 Jul 2027 (estimated)
  4. Study completion30 Jul 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
1,178 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06931275
Sponsor's protocol ID
98752815
Status last verified
Jun 2024
First submitted
9 Sep 2024
Last updated
17 Apr 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: There will be no Individual Participant data collection.

Publications

  • Ebekozien O, Mungmode A, Buckingham D, Greenfield M, Talib R, Steenkamp D, Haw JS, Odugbesan O, Harris M, Mathias P, Dickinson JK, Agarwal S. Achieving Equity in Diabetes Research: Borrowing From the Field of Quality Improvement Using a Practical Framework and Improvement Tools. Diabetes Spectr. 2022 Summer;35(3):304-312. doi: 10.2337/dsi22-0002. Epub 2022 Aug 15.

    PubMed 36072814
  • Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2005 Apr 2;330(7494):765. doi: 10.1136/bmj.38398.500764.8F. Epub 2005 Mar 14.

    PubMed 15767266
  • Flores EJ, Jue JJ, Giradi G, Schoelles K, Mull NK, Umscheid CA. AHRQ EPC Series on Improving Translation of Evidence: Use of a Clinical Pathway for C. Difficile Treatment to Facilitate the Translation of Research Findings into Practice. Jt Comm J Qual Patient Saf. 2019 Dec;45(12):822-828. doi: 10.1016/j.jcjq.2019.10.002. Epub 2019 Oct 28.

    PubMed 31672660
  • Mathioudakis N, Wolf R, Choudhary A, Davis G, Gallagher MP, Gupta M, Kamboj M, Rioles N, Ospelt E, Thapa S, Weinstock RS, Wright T, Ebekozien O. Implementation and Evaluation of a Best Practice Advisory to Reduce Inequities in Technology Use for People With Type 1 Diabetes: Protocol for a Mixed Methods, Nonrandomized Controlled Trial. JMIR Res Protoc. 2025 May 28;14:e71038. doi: 10.2196/71038.

    PubMed 40434817

Questions about this trial

What is this clinical trial studying?

A study testing EMR-based BPA model in people with Diabetes Mellitus, Type 1, run by T1D Exchange, United States at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 17 Apr 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Osagie Ebekozien, MD (857-205-2388, oebekozein@t1dexchange.org), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Progression of Advanced Diabetes Technology use (time frame: 12 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06931275, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Apr 2025.

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