Effectiveness of quality improvement strategies for type 1 diabetes in children and adolescents: a systematic review protocol

Introduction: Optimal glycaemic control is often a challenge in children and adolescents with type 1 diabetes (T1D). Implementation of patient, clinician or organisation-targeted quality improvement (QI) strategies has been proven to be beneficial in terms of improving glycaemic outcomes in adults living with diabetes. This review aims to assess the effectiveness of such QI interventions in improving glycaemic control, care delivery, and screening rates in children and adolescents with T1D. Methods and analysis: MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL databases will be searched for relevant studies up to January 2021. Trial registries, ClinicalTrials.gov and ICTRP, will also be explored for any ongoing trials of relevance. We will include trials which examine QI strategies as defined by a modified version of the Cochrane Effective Practice and Organisation of Care 2015 Taxonomy in children (<18 years) with a diagnosis of T1D. The primary outcome to be assessed is glycated haemoglobin (HbA1c), although a range of secondary outcomes relating to clinical management, adverse events, healthcare engagement, screening rates and psychosocial parameters will also be assessed. Our primary intention is to generate a best-evidence narrative to summarise and synthesise the resulting studies. If a group of studies are deemed to be highly similar, then a meta-analysis using a random effects model will be considered. Cochrane Risk of Bias 1.0 tool will be applied for quality assessment. All screening, data extraction and quality assessment will be performed by two independent researchers. Dissemination: The results of this review will be disseminated through peer-reviewed publication in order to inform invested partners (e.g., Paediatric Endocrinologists) on the potential of QI strategies to improve glycaemic management and other related health outcomes in children with T1D, thereby guiding best practices in the outpatient management of the disorder. PROSPERO registration number: CRD42021233974 (28/02/2021).