Benefits of ECHO Diabetes

This sharing of knowledge has been shown to build confidence among providers who turn knowledge into action and expand treatment of their patients on their own. This approach amplifies and democratizes knowledge and empowers PCPs to not have to rely solely on specialty referrals and to improve health outcomes for their patients with insulin-requiring diabetes.

ECHO Diabetes aims to break down barriers to care for underserved patients who may face racial, socioeconomic, and geographic disparities that affect their health outcomes. Focus groups held by Stanford Medicine, composed of T1D adults in underserved areas of California, found care barriers to include long wait times for endocrinologist appointments, difficulty affording insulin and supplies, poor access to technology and equipment, lack of well-rounded care, and a lack of social support. By bringing specialty care knowledge to rural and underserved areas, ECHO Diabetes hopes to effect change and improve care statistics on outcomes across the state.

ECHO Diabetes is an outgrowth of Project ECHO Type 1 Diabetes, an 18-month pilot study. The pilot was highly recommended by participants and clinics, and it demonstrated improvements in change in practice and confidence among PCPs managing T1D. The T1D-specific pilot study’s success encouraged the adoption of the program and its expansion to include all insulin-requiring people with diabetes.

“ECHO Diabetes is like an efficient mini-fellowship in diabetes management for primary care providers. It is low dose in time commitment and high frequency in application in patient care and system change.”

Nicolas Cuttriss, MD, MPH, assistant clinical professor of endocrinology and diabetes, Stanford Medicine

How ECHO Diabetes works

ECHO Diabetes has continual cohort training sessions for interested primary care providers and clinic groups throughout the year (winter/fall). Cohorts are supported with weekly teleECHO sessions the first six months, then alternating weekly teleECHO sessions for the next six to 18 months. Besides teleECHO sessions, cohorts receive access to multidisciplinary hub specialists outside of teleECHO sessions and access to diabetes support coaches for patients. Interested and accepted clinics will be assigned to start January 2021 or August 2021. To join, contact the ECHO Diabetes team by emailing diabetesecho@stanford.edu

  1. Provider training: cohort orientation by Stanford Medicine
    Clinics accepted to ECHO Diabetes can nominate up to two providers for sponsored travel and education for a weekend orientation at Stanford Medicine. Participants receive an introduction to ECHO Diabetes, meet the multidisciplinary ECHO hub team, receive education on high-yield diabetes management topics in primary care, and participate in a “Diabetes Device Laboratory” to meet representatives from various diabetes device companies and to learn and trial the newest diabetes technology devices. New cohort orientations and trainings take place in the winter and fall. Based on COVID-19 status, virtual trainings will be offered.

  2. TeleECHO sessions: remote tele-education and tele-mentoring
    Diabetes experts from the hub team hold weekly (for the initial six months of the program) one-hour training sessions certified for continuing education and maintenance of certification (typically on Thursdays from 12:15 to 1:15 p.m. PT). Education is presented on specific topics, including initiating insulin and dose calculation, carbohydrate counting and dietary management, insulin pump and continuous glucose monitoring interpretation and management, diabetes and substance use, affording diabetes prescriptions, dealing with diabetes burnout, diabetes and exercise, and many more. Guest experts from the larger Stanford Medicine team also discuss unique challenges that may accompany diabetes. Primary care learners take turns presenting case studies and receiving feedback. After six months of participation, teleECHO sessions are every other week. Recommended participation is 24 months with a minimum of 12 months.

  3. Curbside consults: access to real-time support from multidisciplinary hub team
    Participating providers receive support via a hub specialist (i.e., a pediatric or adult endocrinologist, behavioral health specialist, or diabetes educator) who is available by phone and email to provide real-time guidance.

  4. Diabetes support coaches: support for primary care providers and their patients
    ECHO Diabetes recruits people living with diabetes or their family members to serve as diabetes support coaches to provide additional social support services to patients with diabetes at spoke sites. This additional resource is offered as an opt-in service to spoke sites, and personnel are hired and trained by Stanford Medicine. Patients with insulin-requiring diabetes who are interested in the nonmedical advice services (phone calls, home visits, care navigation, and social gatherings with others who have diabetes) are able to opt in to the Diabetes Support Coach program via a social contract. Diabetes support coaches are local to the community and also work to organize social gatherings (live and via Zoom) for the diabetes community.

  5. Focus on quality improvement: improving diabetes outcomes in your clinic
    Beyond provider education, Stanford Medicine is now preparing to support quality improvement efforts at spoke sites. Quality efforts will focus on improving A1c results and improving HEDIS/NCQA Comprehensive Diabetes Care Measures. ECHO Diabetes will support spokes to prioritize opportunities for improvement in diabetes outcomes, review care delivery strengths on a range of diabetes measures, analyze potential barriers to meeting improvement goals, and plan how to address their goals to enable improved patient outcomes.

Benefits to primary care providers

  • Gain knowledge on best practices for people with T1D and T2D who use insulin from diabetes experts during weekly sessions.
  • Earn free educational credits: AMA PRA Category 1 Credit for physicians; CE credits for nurses, NPs, PAs, and dietitians; and Maintenance of Certification Part 2 for pediatricians and internists at no cost.
  • Participate in quality improvement efforts related to A1c and HEDIS/NCQA Comprehensive Diabetes Care Measures to meet payer quality goals around patient outcomes.
  • Receive patient and practice support from diabetes support coaches and hub specialists.
  • Utilize direct patient support from diabetes support coaches.
  • Access device companies and other diabetes resources.
  • Learn about new continuous glucose monitoring (CGM) technologies and real-time data sharing with patients.

Join ECHO Diabetes

We welcome you to join our community of practice by submitting a very brief application via this link: Apply to participate > 

If you would like to participate in an information session or have additional questions, please email diabetesecho@stanford.edu.