Using provider education to expand specialty diabetes care to the underserved


For many underserved type 1 diabetes patients the ability to seek specialist care is out of reach for a variety of reasons. One program discussed at the virtual Scientific Sessions for the American Diabetes Association seeks to change that by empowering primary care providers through education to provide much-needed specialist care to those patients.

Disparities in type 1 diabetes lead to harmful consequences such as higher levels of hemoglobin A1c levels than the <7% target for patients aged younger than 18 years and <7.5% for patients aged older than 18 years. Some of these disparities that can impact this include having a lower family income, utilizing public insurance, being non-Hispanic Black or Hispanic, and no access to continuous glucose monitoring. Many pediatric diabetes patients also have a variety of barriers that prevent the utilization of endocrinology services that can lead to better outcomes and control. Ashby Walker, PhD, director for Health Equity Initiatives at the University of Florida Diabetes Institute in Gainesville, spoke about Project ECHO, which stands for Extension for Community Healthcare Outcomes, and how it could help lead to reductions in disparities by empowering primary care providers to provide care typically offered by specialists, at the 81st virtual Scientific Sessions for the American Diabetes Association.

The goal of Project ECHO is to share the knowledge of medical specialties with primary care providers, which allows them to provide specialty care to their patients who may not be able to receive specialty care because of an inability to take time away from work for another medical appointment, a lack of availability in the area, or not being comfortable with specialty providers. Primary care providers attend 1 hour sessions that include concepts and a deidentified case study to put the concepts into action. Providers receive continuing medical education credit for attending the courses. The program was initially started to treat hepatitis C in New Mexico and has expanded to include numerous institutions and diseases.

The Project ECHO program for type 1 diabetes was launched by the University of Florida Diabetes Institute and Stanford University in 2018. When it initially launched, the program surveyed primary care practitioners; performed focus groups in adults with type 1 diabetes who were considered high needs about their experiences; and performed geocoding to identify catchment areas. In addition to the education programs, providers also have access to real-time support with the Project ECHO hub of specialty providers and access to an online collection of educational modules. Some of the topics presented were motivational interviewing, transitioning from pediatric to adult care, affording diabetes prescriptions, and introducing diabetes technology to patients. The program also includes diabetes support coaches who are people living with diabetes and can provide peer support as well as develop resource guides and organize social events.


1. Walker A. ECHO diabetes: delivering care to the underserved. American Diabetes Association Scientific Sessions 2021; June 26, 2021; virtual. Accessed June 26, 2021.

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