Background: Limited data exist regarding diabetes technology use among adults with type 1 diabetes (T1D) in urban racially/ethnically diverse safety-net hospitals. We examined racial/ethnic differences in the use of continuous glucose monitor (CGM) and continuous subcutaneous insulin infusion (CSII) in this setting. Methods: A retrospective review of 227 patients ≥ 18 years of age with T1D seen in an urban, safety-net endocrinology clinic during 2016-2017 was completed (mean age: 39; 80% English-speaking; 50% had public insurance). Diabetes technology use, defined as either CGM or CSII or both CGM and CSII, and clinical outcomes were examined by race/ethnicity. Results: Overall, 30% used CGM and 26% used CSII. After adjusting for age, language, insurance, and annual income, diabetes technology use in non-White patients was significantly lower than in White patients, predominantly lower in Black (aOR 0.25 [95% CI 0.11-0.56]) and patients identified as other race/ethnicity (aOR 0.30 [95% CI 0.11-0.77]). At the highest household income level (≥$75,000/y), Black and Hispanic individuals were significantly less likely than White individuals to use diabetes technology ( P < .0007). Mean hemoglobin A1c (HbA1c) was lower in patients using any diabetes technology compared with patients using no technology ( P < .0001). Use of CGM and CSII together was associated with the lowest HbA1c across all racial/ethnic groups. Conclusions: Racial/ethnic disparities in diabetes technology use and glycemic control were observed even after adjusting for sociodemographic factors. Further research should explore barriers to accessing diabetes technology in non-White populations.

We present the case of a 27-year-old woman with inadequately controlled HNF1A maturity-onset diabetes of the young (MODY) who was successfully transitioned from sulfonylurea therapy to once-weekly monotherapy with dulaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA). More than a decade from diabetes diagnosis, she has maintained optimal glycemic control without hypoglycemia for >12 months while receiving GLP-1 RA therapy alone. This case illustrates the potential for successful use of GLP-1 RA monotherapy in patients with HNF1A MODY.

In this commentary, we briefly review the currently recommended approaches to interpretation and management of continuous glucose monitor (CGM) rate of change (ROC) trend arrows and discuss the inherent difficulty in incorporating practical recommendations for their application into routine clinical care. We have limited our review and discussion to the currently available Dexcom G5 and G6 CGM systems and Abbott’s Freestyle Libre flash glucose monitor (FGM) system, as they are the most widely used and currently approved for nonadjunctive use in the United States.