O3279: Diabetes and School Health (DASH) Program: Optimizing Care, Outcomes and Access among students with Type 1 Diabetes

Background: Healthcare inequities, psychosocial and educational challenges, and inconsistent execution of diabetes care plans result in suboptimal outcomes and complications. Diabetes and School Health (DASH) program is an equity based, inter-disciplinary program.

Methods: DASH enrollment was open to patients with type 1 diabetes (T1D) enrolled in kindergarten to 12th grade with moderate or high risk of complications based on their Diabetes Composite Score, a novel risk assessment tool developed by our institution (score < 13, indicating increased risk). The clinic at our hospital cares for > 3000 patients with T1D. 17% were eligible during the DASH pilot year. DASH staff completed on-site 1:1, monthly clinical visits to students with T1D, inclusive of education to students/staff, addressing medical/psychosocial concerns, providing referrals to specialty care, coordinating scheduled delivery of medications/supplies, and facilitating communication between families, school staff and diabetes team. In the third year of operation, DASH began to utilize telehealth to provide care over the summer. Clinical data and surveys for program evaluation were obtained from students, caregivers, and staff, including A1C, acute care utilization, educational mastery, psychosocial, and demographic measures.

Results: Through 4 years of the program, DASH provided school centered diabetes care to 133 students over 1600 visits, in 126 schools and 14 school districts. Within the last operating year, ~80% of the population identified as an ethnic minority, with 69% identifying as Black. During this time, A1c improved from 12.4% to 10.1%, regular continuous glucose monitor use (CGM) increased from 16% to 88% and insulin pump use increased from 7% to 43%. In addition, access to diabetes care through the summer was maintained by telehealth visits. The DASH team completed 40 telehealth visits over a 3-month period, optimized diabetes care, and made referrals to care coordination, psychology, dental clinic, and primary care.

Insulin pump use increased among the minority population from 18% in Year 1 to 25% of Blacks and 36% other non-White students by Year 4. Regular CGM use also increased from 78% in Year 1 to 86% of Blacks and 81% other non-White students by Year 4.

Conclusion: DASH is a novel school-based health equity program which provides frequent high level inter-disciplinary clinical care to students at high risk of T1D complications. The DASH program has been effective increasing utilization of diabetes technology, improving glycemic control, improving diabetes care access through telehealth and care coordination, and highlights the importance of advocating for consistency in school based T1D care. DASH is an innovative health equity strategy to identify and reduce health disparities among the minority population to improve outcomes.