Using provider education to expand specialty diabetes care to the underserved

Differences in type 1 diabetes lead to adverse outcomes, such as higher hemoglobin A1c levels than the target of <7% for patients under 18 years of age and <7.5% for patients over 18 years of age. Some of these inequalities that could affect this include lower family income, using public insurance, being non-Hispanic black or Hispanic, and not having access to continuous glucose monitoring. Many pediatric diabetic patients also have a variety of barriers that prevent the use of endocrinology services, which can lead to better outcomes and control. Ashby Walker, PhD, director of Health Equity Initiatives at the Diabetes Institute at the University of Florida in Gainesville, spoke about Project ECHO, which stands for Extension for Community Healthcare Outcomes, and how it can help reduce inequalities by empowering primary care providers. to care typically provided by specialists, during the 81st Virtual Science Sessions for the American Diabetes Association.

The aim of Project ECHO is to share knowledge of medical specialties with primary care providers, enabling them to provide specialized care to their patients who may not be able to receive special care because they are unable to take time off their work for another medical appointment, lack of availability in the area, or not being comfortable with specialist providers. Primary care providers attend 1-hour sessions with concepts and an anonymized case study to put the concepts into action. Providers receive continuing education credit for taking 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 in 2018 by the University of Florida Diabetes Institute and Stanford University. When the program first started, the program surveyed frontline workers; conducted focus groups on adults with type 1 diabetes who were perceived as having high needs for their experiences; and performed geocoding to identify watersheds. In addition to the education programs, providers also have access to real-time support with the Project ECHO hub of specialist providers and access to an online collection of educational modules. Some of the topics presented included motivational interviewing, transitioning from pediatric to adult care, dispensing diabetes prescriptions, and introducing diabetes technology to patients. The program also includes diabetes support coaches who are people with diabetes who can provide peer support, develop guides and organize social events.


1. Walker A. ECHO diabetes: providing care to the less fortunate. American Diabetes Association Scientific Sessions 2021; June 26, 2021; virtual. Access until June 26, 2021.

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