Improving Continuous Glucose Monitoring Uptake in Underserved Youth with Type 1 Diabetes: The IMPACT Study

Lin, Tyger; Manfredo, Jacqueline A; Illesca, Nicole; Abiola, Kai; Hwang, Nearry; Salsberg, Sandra; Akhtar, Yasmin; Mathioudakis, Nestoras; Brown, Elizabeth; Wolf, Risa M.

doi:10.1089/dia.2022.0347

Cited by 9 publications

(9 citation statements)

References 30 publications

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“…However, for those individuals who enrolled in remote monitoring, we ensured cloud connectivity and the ability to engage in remote monitoring by providing smart devices if needed. Although we offered smart devices with internet connectivity for families who received remote monitoring, we observed a “digital divide” in their use, which has been well documented in minoritized populations . Despite these limitations, Hispanic youths and youths with public insurance, who are underrepresented in research, allowed us to explore aspects of care unique to these groups.…”

Section: Discussionmentioning

confidence: 99%

“…Although we offered smart devices with internet connectivity for families who received remote monitoring, we observed a “digital divide” in their use, which has been well documented in minoritized populations. 51 , 52 Despite these limitations, Hispanic youths and youths with public insurance, who are underrepresented in research, 53 allowed us to explore aspects of care unique to these groups. Given the increasing incidence and prevalence of T1D among Hispanic or Latinx youths, these data are particularly insightful for this growing proportion of new-onset T1D.…”

Section: Discussionmentioning

confidence: 99%

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Disparities in Hemoglobin A_1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

et al. 2023

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ImportanceContinuous glucose monitoring (CGM) is associated with improvements in hemoglobin A1c (HbA1c) in youths with type 1 diabetes (T1D); however, youths from minoritized racial and ethnic groups and those with public insurance face greater barriers to CGM access. Early initiation of and access to CGM may reduce disparities in CGM uptake and improve diabetes outcomes.ObjectiveTo determine whether HbA1c decreases differed by ethnicity and insurance status among a cohort of youths newly diagnosed with T1D and provided CGM.Design, Setting, and ParticipantsThis cohort study used data from the Teamwork, Targets, Technology, and Tight Control (4T) study, a clinical research program that aims to initiate CGM within 1 month of T1D diagnosis. All youths with new-onset T1D diagnosed between July 25, 2018, and June 15, 2020, at Stanford Children’s Hospital, a single-site, freestanding children’s hospital in California, were approached to enroll in the Pilot-4T study and were followed for 12 months. Data analysis was performed and completed on June 3, 2022.ExposuresAll eligible participants were offered CGM within 1 month of diabetes diagnosis.Main Outcomes and MeasuresTo assess HbA1c change over the study period, analyses were stratified by ethnicity (Hispanic vs non-Hispanic) or insurance status (public vs private) to compare the Pilot-4T cohort with a historical cohort of 272 youths diagnosed with T1D between June 1, 2014, and December 28, 2016.ResultsThe Pilot-4T cohort comprised 135 youths, with a median age of 9.7 years (IQR, 6.8-12.7 years) at diagnosis. There were 71 boys (52.6%) and 64 girls (47.4%). Based on self-report, participants’ race was categorized as Asian or Pacific Islander (19 [14.1%]), White (62 [45.9%]), or other race (39 [28.9%]); race was missing or not reported for 15 participants (11.1%). Participants also self-reported their ethnicity as Hispanic (29 [21.5%]) or non-Hispanic (92 [68.1%]). A total of 104 participants (77.0%) had private insurance and 31 (23.0%) had public insurance. Compared with the historical cohort, similar reductions in HbA1c at 6, 9, and 12 months postdiagnosis were observed for Hispanic individuals (estimated difference, −0.26% [95% CI, −1.05% to 0.43%], −0.60% [−1.46% to 0.21%], and −0.15% [−1.48% to 0.80%]) and non-Hispanic individuals (estimated difference, −0.27% [95% CI, −0.62% to 0.10%], −0.50% [−0.81% to −0.11%], and −0.47% [−0.91% to 0.06%]) in the Pilot-4T cohort. Similar reductions in HbA1c at 6, 9, and 12 months postdiagnosis were also observed for publicly insured individuals (estimated difference, −0.52% [95% CI, −1.22% to 0.15%], −0.38% [−1.26% to 0.33%], and −0.57% [−2.08% to 0.74%]) and privately insured individuals (estimated difference, −0.34% [95% CI, −0.67% to 0.03%], −0.57% [−0.85% to −0.26%], and −0.43% [−0.85% to 0.01%]) in the Pilot-4T cohort. Hispanic youths in the Pilot-4T cohort had higher HbA1c at 6, 9, and 12 months postdiagnosis than non-Hispanic youths (estimated difference, 0.28% [95% CI, −0.46% to 0.86%], 0.63% [0.02% to 1.20%], and 1.39% [0.37% to 1.96%]), as did publicly insured youths compared with privately insured youths (estimated difference, 0.39% [95% CI, −0.23% to 0.99%], 0.95% [0.28% to 1.45%], and 1.16% [−0.09% to 2.13%]).Conclusions and RelevanceThe findings of this cohort study suggest that CGM initiation soon after diagnosis is associated with similar improvements in HbA1c for Hispanic and non-Hispanic youths as well as for publicly and privately insured youths. These results further suggest that equitable access to CGM soon after T1D diagnosis may be a first step to improve HbA1c for all youths but is unlikely to eliminate disparities entirely.Trial RegistrationClinicalTrials.gov Identifier: NCT04336969

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Disparities in Hemoglobin A_1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

et al. 2023

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“…However, the authors did report improved uptake of personal CGM, which may reduce disparities in CGM use among minorities and underserved communities. 31 …”

Section: Introductionmentioning

confidence: 99%

“…However, the authors did report improved uptake of personal CGM, which may reduce disparities in CGM use among minorities and underserved communities. 31 There has been an overwhelming amount of data published in recent years demonstrating the impact of CGM on the development of diabetes-related complications such as nephropathy, retinopathy, neuropathy, and cardiovascular events. 32,33 One study demonstrated that improved TIR over 1 year is associated with reduced albuminuria in patients with T1D who use a sensor augmented insulin pump.…”

mentioning

confidence: 99%

Use of Continuous Glucose Monitors to Manage Type 1 Diabetes Mellitus: Progress, Challenges, and Recommendations

Friedman¹,

Matos²,

Szmuilowicz³

2023

PGPM

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Type 1 diabetes (T1D) management has been revolutionized with the development and routine utilization of continuous glucose monitoring (CGM). CGM technology has allowed for the ability to track dynamic glycemic fluctuations and trends over time allowing for optimization of medical therapy and the prevention of dangerous hypoglycemic events. This review details currently-available real-time and intermittently-scanned CGM devices, clinical benefits, and challenges of CGM use, and current guidelines supporting its use in the clinical care of patients with T1D. We additionally describe future issues that will need to be addressed as CGM technology continues to evolve.

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“…Our findings are similar to a quality improvement initiative providing sample CGMs in an adult diabetes clinic, 5 and in a clinical trial in pediatrics. 6 Many diabetes practices across the country utilize sample CGM programs to provide CGMs at the point-of-care. This may be a feasible strategy to improve personal CGM uptake and sustained use in a real-world setting, especially in underserved and minority populations.…”

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confidence: 99%

Providing Point-of-Care Sample CGM Increases Uptake of Personal CGM

ZEHRA

Brown

Wolf

2022

J Diabetes Sci Technol

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Improving Continuous Glucose Monitoring Uptake in Underserved Youth with Type 1 Diabetes: The IMPACT Study

Cited by 9 publications

References 30 publications

Disparities in Hemoglobin A_1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

Disparities in Hemoglobin A_1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

Use of Continuous Glucose Monitors to Manage Type 1 Diabetes Mellitus: Progress, Challenges, and Recommendations

Providing Point-of-Care Sample CGM Increases Uptake of Personal CGM

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Improving Continuous Glucose Monitoring Uptake in Underserved Youth with Type 1 Diabetes: The IMPACT Study

Cited by 9 publications

References 30 publications

Disparities in Hemoglobin A1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

Disparities in Hemoglobin A1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

Use of Continuous Glucose Monitors to Manage Type 1 Diabetes Mellitus: Progress, Challenges, and Recommendations

Providing Point-of-Care Sample CGM Increases Uptake of Personal CGM

Contact Info

Product

Resources

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Disparities in Hemoglobin A_1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

Disparities in Hemoglobin A_1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring