T1D Exchange

Effectively addressing the climate crisis at scale in a timely manner will require novel engagement strategies that move beyond laboratory findings and policy dictates. In this practice insight, we present the Moving Farm Tour, a movement-based, farm- and community-centered exploration of the intersection of art and culture with agriculture and climate change. Through this model, we highlight the use of dance and creative engagement as tangible mechanisms for learning about, sharing, understanding and creating new perspectives. Additionally, we demonstrate the value of not only bringing science (and scientists) out of the lab, but of establishing a visceral, physical connection with place and community. Our collaborative efforts have resulted in a scalable, replicable model that demonstrates how live, interactive experiences are useful for cross-sector learning, broadening perspectives, fostering community building, and inspiring novel approaches to collaboration that can lead to better outcomes for researchers, industries, communities, and the planet.

The Florida Department of Corrections is the third largest prison system in the United States with 82,124 inmates and a recidivism rate averaging 23% (Florida Department of Corrections, 2022a, 2022b; World Population Review, 2025). Previous research has advocated for more structured and meaningful resources for occupying free time in correctional settings to decrease recidivism risk (Link & Williams, 2017). Leisure Education can address these concerns. Exchange for Change is a nonprofit organization offering skills-building courses through writing activities to incarcerated individuals. This article describes the 2023 development of a Leisure Education curriculum for a correctional population within the context of the Exchange for Change writing program. Broad outcomes for the program included enhancement of participants’ writing and verbal communication skills, as well as participants’ ability to describe the value of leisure in their own lives, their leisure motivations, and their leisure interests.

To quantify mortality trends among female individuals of childbearing age (15-49 years) across global regions from 1990 to 2021, systematically evaluating persistent geographic inequities in preventable deaths. We analyzed data from the GBD (Global Burden of Diseases, Injuries, and Risk Factors Study) 2021, focusing on five leading causes of maternal mortality: hemorrhage, hypertensive disorders, sepsis and infections, obstructed labor and uterine rupture, and abortion and miscarriage. We calculated estimated annual percent change (APC) in age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) for these conditions, stratified by age group and sociodemographic index, to examine temporal trends. Joinpoint regression identified trends and inflection points in age and sociodemographic index stratification. Spearman correlation analysis assessed the relationship between ASIRs and sociodemographic index levels. Globally, an estimated 102,854,299 new incident cases of the five major maternal disorders and 129,331 deaths were reported in 2021. Between 1990 and 2021, the ASIR declined annually by -1.4% (95% CI, -1.5% to -1.3%) (estimated APC), and the ASMR decreased even more substantially at -3.6% (95% CI, -3.7% to 3.4%) per year. Annual declining trends in ASIR and ASMR were observed across all leading causes of maternal mortality. However, regions such as Central Sub-Saharan Africa still reported persistently high rates. Epidemiologic curves revealed peak mortality in the age stratum of 20-24 years, with progressive attenuation to nadir levels in individuals aged 45-49 years. Although abortion or miscarriage became increasingly prevalent as a cause of death worldwide over three decades, maternal hemorrhage remained the leading cause of death, accounting for 35.8% of deaths globally. Higher sociodemographic index correlated with declining ASIR and ASMR trends overall. Notably, sepsis-related mortality increased in younger cohorts, and high-middle-sociodemographic index regions achieved the steepest ASMR and ASIR reductions from 1990 to 2006. Joinpoint regression identified inflection points in incidence and mortality trends in age- and sociodemographic index-stratified populations over time. There was a substantial global reduction in maternal mortality between 1990 and 2021; however, Central Sub-Saharan Africa persists as the most critical regional hotspot. Maternal hemorrhage was the leading cause of death. The Sociodemographic index serves as a robust predictor of mortality, necessitating precision-targeted interventions that prioritize geographic regions with both elevated risk and obstetric complications.

OBJECTIVETo determine how diabetes technologies, including continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems, impact glycemic metrics, prevalence of severe hypoglycemic events (SHEs), and impaired awareness of hypoglycemia (IAH) in people with type 1 diabetes in a real-world setting within the U.S.RESEARCH DESIGN AND METHODSIn this retrospective, observational study with cross-sectional elements, participants aged ≥18 years were enrolled from the T1D Exchange Registry/online community. Participants completed a one-time online survey describing glycemic metrics, SHEs, and IAH. The primary objective was to determine the proportions of participants who reported achieving glycemic targets (assessed according to self-reported hemoglobin A1c) and had SHEs and/or IAH. We performed additional subgroup analyses focusing on the impact of CGM and insulin delivery modality.RESULTSA total of 2,074 individuals with type 1 diabetes were enrolled (mean ± SD age 43.0 ± 15.6 years and duration of type 1 diabetes 26.3 ± 15.3 years). The majority of participants (91.7%) were using CGM, with one-half (50.8%) incorporating AID. Despite high use of diabetes technologies, only 57.7% reported achieving glycemic targets (hemoglobin A1c <7%). SHEs and IAH still occurred, with ∼20% of respondents experiencing at least one SHE within the prior 12 months and 30.7% (95% CI 28.7, 32.7) reporting IAH, regardless of CGM or AID use.CONCLUSIONSDespite use of advanced diabetes technologies, a high proportion of people with type 1 diabetes do not achieve glycemic targets and continue to experience SHEs and IAH, suggesting an ongoing need for improved treatment strategies.

Previous studies revealed that HbA1c increased overall in the U.S. in the past decade. Additionally, health inequities in type 1 diabetes (T1D) outcomes by race-ethnicity and insurance type persist. This study examines the trends in HbA1c from 2016 to 2022 stratified by race-ethnicity and insurance in a large multicenter national database. We analyzed glycemic outcomes and diabetes device use trends for over 48,000 people living with type 1 diabetes (PwT1D) from three adult and twelve pediatric centers in the T1D Exchange Quality Improvement Collaborative (T1DX-QI), comparing data from 2016-2017 with data from 2021-2022. The mean HbA1c in 2021-2022 was lower at 8.4% compared to the mean HbA1c in 2016-2017 of 8.7% (0.3% improvement; p<0.01). Over the same period, the percentage of PwT1D using a continuous glucose monitor (CGM), insulin pump, or hybrid closed-loop system increased (45%, 12%, and 33%, respectively). However, these improvements were not equitably demonstrated across racial-ethnic groups or insurance types. Racial-ethnic and insurance-based inequities persisted over all seven years across all outcomes; comparing non-Hispanic White and non-Hispanic Black PwT1D, disparate gaps in HbA1c (1.2-1.6%), CGM (30%), pump (25-35%), and HCLS (up to 20%) are illuminated. Population-level data on outcomes, including hemoglobin A1c (HbA1c), can provide trends and insights into strategies to improve health for PwT1D. The T1DX-QI cohort showed a significant improvement in HbA1c from 2016-2022. Improvements in diabetes device use are also demonstrated. However, these increases were inconsistent across all racial-ethnic groups or insurance types, an important focus for future T1D population health improvement work.

Social determinants of health (SDOH) are strongly associated with outcomes for people with type 1 diabetes. Six centers in the T1D Exchange Quality Improvement Collaborative applied quality improvement principles to design iterative Plan-Do-Study-Act cycles to develop and expand interventions to improve SDOH screening rates. The interventions tested include staff training, a social risk index, an electronic health record patient-facing portal, partnerships with community organizations, and referrals to community resources. All centers were successful in improving SDOH screening rates, with individual site improvements ranging from 41 to 70% and overall screening across the six centers increasing from a baseline of 1% to 70% in 27 months.

Managing type 1 diabetes in young children can cause significant stress for parents. Continuous glucose monitoring (CGM) may reduce parental burden. The Strategies to Enhance CGM Use in Early Childhood (SENCE) trial randomized parents of children (ages 2 to <8 years) with type 1 diabetes to CGM with family behavioural intervention (CGM + FBI), CGM alone (Standard-CGM) or blood glucose monitoring for 26 weeks before receiving CGM + FBI (BGM-Crossover). This report assesses changes in psychosocial outcomes for all groups over 52 weeks. CGM + FBI (n = 45), Standard-CGM (n = 42) and BGM-Crossover (n = 44) participants completed psychosocial assessments at baseline, 26 weeks and 52 weeks. Repeated measures linear regression models evaluated change within and between treatment groups. The BGM-Crossover group reported improved diabetes burden (Δ -6.9, 95% CI [-11.3, -2.6], p = 0.003), fear of hypoglycaemia (Δ -6.4, CI [-10.1, -2.6], p = 0.002) and technology satisfaction (Δ 7.3, CI [2.4, 12.2], p = 0.005) from 26 to 52 weeks, similar to published findings in the CGM + FBI group over the first 26 weeks. The Standard-CGM group reported increased technology satisfaction (Δ 7.3, CI [0.6, 14.0], p = 0.027) from baseline to 52 weeks. The CGM + FBI group reported less diabetes burden and fear of hypoglycaemia from baseline to 52 weeks, but changes were not statistically significant. Scores from 26 to 52 weeks did not deteriorate. Parents demonstrated psychosocial benefits following FBI that appeared to maintain without additional intervention. CGM-focused education with behavioural support likely helps parents of young children with type 1 diabetes reduce burden and worry in the short- and long-term.