CGM use less likely for children with type 1 diabetes living in rural vs. urban areas
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Key takeaways:
- Children are less likely to use continuous glucose monitoring if they live in small or isolated rural towns vs. urban areas.
- Living in a neighborhood with worse deprivation is linked to lower odds of CGM use.
Children with type 1 diabetes living in small or isolated rural towns are less likely to use continuous glucose monitoring than those living in urban areas, according to data published in Diabetes Care.
“Rural geography is a significant barrier to access among pediatric patients with type 1 diabetes, a previously understudied population,” Daniel R. Tilden, MD, MPH, an endocrinologist in the division of endocrinology, diabetes and clinical genetics, department of medicine at the University of Kansas Medical Center, told Healio. “Over the last decade, the field has developed a growing awareness of the ways that our health care systems serve and don’t serve various groups who have difficulty accessing our existing systems, such as minoritized racial and ethnic groups. This work shows that people living in rural communities experience these barriers as well. As we as a field work to improve our care delivery, addressing the needs of folks living in these remote communities should be a part of the conversation as we work to develop more inclusive care systems.”
Tilden and colleagues conducted a retrospective cohort study of children and adolescents with type 1 diabetes who attended at least one clinic visit in the Vanderbilt Pediatric Diabetes Program each year from 2018 to 2021. Each participant was assigned a rural-urban commuting area and a neighborhood deprivation index value based on the U.S. Census tract of their home address. Children were identified as using a CGM if there was a CGM interpretation CPT code in their medical record.
Lower CGM use for children in rural areas
The study included 2,008 children with type 1 diabetes who completed 13,645 patient visits from 2018 to 2021 (52.9% boys; 78.8% white). Of the total visits, 40.2% included a CGM code, and 67.5% of the study population has at least one CGM code in their record during the study period.
Of the study visits, 68.2% were attended by children living in urban areas, 21.3% were attended by children living in large rural towns, 7.7% were attended by children from small rural towns and 2.8% of visits were of children from isolated small rural towns.
In adjusted regression analysis, children living in small rural towns (adjusted OR = 0.69; 95% CI, 0.51-0.94) and those living in isolated small rural towns (aOR = 0.51; 95% CI, 0.28-0.92) were less likely to have a CGM code during a clinic visit than children living in urban areas. No difference in CGM use was observed between children living in large rural towns vs. urban areas.
Disparities in pediatric CGM use
Children who had public insurance were less likely to use CGM than those with private insurance (aOR = 0.58; 95% CI, 0.48-0.69). Non-Hispanic Black youths (aOR = 0.48; 95% CI, 0.35-0.65), Hispanic youths (aOR = 0.54; 95% CI, 0.33-0.86) and children of other racial-ethnic backgrounds (aOR = 0.64; 95% CI, 0.48-0.85) had lower odds for CGM use than non-Hispanic white children. Children with a higher HbA1c had a lower likelihood of using CGM (aOR = 0.72; 95% CI, 0.69-0.74).
When participants were separated into neighborhood deprivation index quartiles, rates of CGM use by children in the top three quartiles increased more than among children in the lowest quartile. Children who lived in an area with worse neighborhood deprivation were less likely to use CGM than those living in less-deprived neighborhoods (aOR = 0.84; 95% CI, 0.77-0.92).
Tilden said more studies are needed to assess qualitative data that is not available through medical records, develop interventions to improve CGM use in rural populations and to conduct similar research among adults living in rural areas.
“For clinicians, I think this highlights the need for us to be aware of the everyday challenges experienced by our patients in getting the care they need,” Tilden said. “This work highlights geography as a potential barrier, but each patient has a much larger set of circumstances that they bring with them to our offices. Clinicians like myself should work with our patients to identify the ways that these circumstances might challenge or facilitate care plans so that we can work to help patients and their families take control of their diabetes care.”
For more information:
Daniel R. Tilden, MD, MPH, can be reached at dtilder@kumc.edu.
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