How a program fares at reducing inequities in type 1 diabetes care


Disparities in type 1 diabetes care can influence long-term outcomes. A presentation at the virtual Scientific Sessions for the American Diabetes Association examined how the Novel Interventions in Children's Healthcare program performed in reducing inequities in outpatient care access.

Disparities are common in health care and can be linked to where a person lives, what race/ethnicity that person is, how financially comfortable the person is, etc. To address these concerns, programs have been developed to tackle the issues. One such program is the Novel Interventions in Children's Healthcare (NICH) program developed at the Oregon Health & Science University in Portland. At the 81st virtual Scientific Sessions for the American Diabetes Association, David Wagner, PhD, associate professor and NICH research director, and Winniebhelle Cadiz, BUILD EXITO scholar, discussed the effect of the NICH program in children and adolescents with type 1 diabetes.

The NICH program was designed to help families with children who have a complex or chronic condition who have limited resources and face social or personal challenges that make managing a child’s condition difficult. The program pairs the family with an interventionist who is available 24/7 to the family. The interventionist meets with the medical team managing the child’s condition and also meets with the child and family either weekly or biweekly in the home. He or she also helps arrange medical appointments, attends clinical visits, and connects the family to resources such as translators, food assistance programs, and transportation help. Type 1 diabetes is just one of many conditions that can qualify a family for the NICH program.

Enrollment in NICH has been linked to fewer complications such as pediatric intensive care unit contact and diabetic ketoacidosis admissions as well as a reduction in the frequency of complications like emergency department visits and admissions. Wagner and his team wanted to see what the relationship was between being a part of the NICH program and access to recommended outpatient care. There were 144 children included with 51 who were part of the program and 92 who were not able to be in the program. The average age was 13.7 years and 81% of the participants were non-Hispanic White. Although not ideal, all non-White participants were grouped into an intervention Black, Indigenous, Person of color (BIPOC) group and a control BIPOC group due to the small sample size. The research team found that there was little overall difference to outpatient appointment attendance in the NICH group, but when only the NICH BIPOC group was examined there was a significant improvement in outpatient appointment attendance. BIPOC children who were not part of NICH had the lowest rates of care access. The results indicate that NICH can address health care access disparities in care for BIPOC children significantly who would otherwise struggle to get access to care.

Wagner and Cadiz did note that the original NICH groups were overwhelmingly non-Hispanic White and that further groups for the program were going to represent a more diverse patient population.


1. Wagner D, Cadiz, W. Reducing racial/ethnic inequities in youth with T1D: novel interventions in children's healthcare (NICH). American Diabetes Association Scientific Sessions 2021; June 25, 2021; virtual. Accessed June 25, 2021.

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