Diabetes Device Use and Glycemic Control among Youth with Type 1 Diabetes: A Single-Center, Cross-Sectional Study

Abstract

Aim The purpose of this cross-sectional study was to determine the rates of diabetes device use (insulin pump and continuous glucose monitor (CGM)) and association with glycemic control in youth with type 1 diabetes in a large, diverse pediatric center. Methods Demographic and clinical data were obtained from 1992 patients who met the eligibility criteria (age < 26 years, diabetes duration ≥ 1 year, and ≥1 clinic visit in the preceding 12 months). Statistical analyses assessed the likelihood of device use based on demographic characteristics and the association between device use and glycemic control based on most recent hemoglobin A1c (HbA1c). Results Mean age was 13.8 ± 4.2 years, 50.7% were female, diabetes duration was 6.2 ± 4 years, and mean HbA1c was 8.7 ± 1.8%. Overall, 38.2% of patients were on pump therapy and 18.5% were on CGM. Patients who were non-Hispanic (NH) white, privately insured, and with primary English-speaking parent(s) had higher rates of insulin pump use, as well as CGM use (P < 0.001 for both). Female patients had higher rates of pump use only (P < 0.01). Private health insurance, NH white race/ethnicity, and CGM use were each associated with lower HbA1c (P = 0.03, <0.001, and <0.008, resp.). Conclusion At a large, diverse, pediatric diabetes center, disparities in diabetes device use were present across sex, race/ethnicity, health insurance coverage, and primary language of parent(s). CGM use was associated with lower HbA1c. Quality improvement efforts are underway to ensure improved access, education, and clinical programs for advanced diabetes devices for T1D patients.

Clouds and Silver Linings: COVID-19 Pandemic Is an Opportune Moment to Democratize Diabetes Care Through Telehealth

“…17 People with type 1 diabetes (T1D) currently using personal CGM and insulin pump therapy are predominantly female, white, with health insurance, and a high level of education. 18,19 In T1D, there are existing disparities in health outcomes related to the ability to access diabetes technologies and the long-term trajectory of HbA 1c levels, which are less favorable for racial minorities. 20 Whether this is due to implicit bias when clinicians are considering offering diabetes technologies to certain groups is not known, but there is evidence that clinicians exhibit the same levels of implicit bias as the wider population.…”

The Role of Continuous Glucose Monitoring, Diabetes Smartphone Applications, and Self-Care Behavior in Glycemic Control: Results of a Multi-National Online Survey

“…Interestingly, the use of CGM technology for glucose monitoring was inversely associated with both hyperglycemia and hypoglycemia among respondents with type 1 DM. In comparison, in numerous other experimental and observational studies, the use of CGM was associated with improved glycemic control [79,80,81]. CGM plays an important role in successful glycemic control by helping patients to timely and effectively detect and counteract hyperglycemia and hypoglycemia.…”

Patterns of Continuous Glucose Monitor Use in Young Children Throughout the First 18 Months Following Type 1 Diabetes Diagnosis

“…28 Future studies should examine mechanisms that may explain the association between insurance type and CGM use among larger sample sizes, with special consideration to reasons families are not presented with the option to begin technology use soon after diagnosis and barriers inherent in the CGM initiation process (e.g., navigating durable medical equiptment). 9,14,27 Continued research exploring characteristics of families who sustain or cease device use over time informs clinical care, highlighting the importance of increasing access to and education around diabetes technology across demographic groups to ultimately improve health outcomes.…”

“…[11][12][13] Furthermore, English-speaking, non-Hispanic, White families report higher rates of device uptake and sustained use than that of families of color. 10,14,15 Overall, very little is known about the uptake and patterns of CGM use and glycemic outcomes in young children, particularly those newly diagnosed with T1D. Even less is known about the sociodemographic and parent psychosocial characteristics that relate to CGM use.…”