CGM barriers lead to worse short-term HbA1c for youths with type 1 diabetes
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Key takeaways:
- Youths from racial-ethnic minority groups and those with public insurance took longer to start CGM after type 1 diabetes diagnosis.
- Starting CGM more than 6 months after diagnosis was tied to higher HbA1c.
ORLANDO — Health care inequities led to some children and adolescents starting continuous glucose monitoring more than 6 months after a type 1 diabetes diagnosis, according to data presented here.
In a cross-sectional analysis presented at the American Diabetes Association Scientific Sessions, youths from racial-ethnic minority groups had a longer time to CGM initiation than white youths and those with public insurance took longer to start CGM after a type 1 diabetes diagnosis than youths with private insurance. Mette K. Borbjerg, MD, of the Steno Diabetes Center North Denmark and the division of pediatric endocrinology at University of California, San Francisco (UCSF), said the findings are critical as the analysis showed children and adolescents who waited more than 6 months after their type 1 diabetes diagnosis to start CGM had a median HbA1c of 8.4% compared with an HbA1c of 7.5% for those who started CGM within 6 months of diagnosis.
“This difference is very big,” Borbjerg told Healio. “Higher HbA1c long term can lead to complications. [Reducing barriers] should be a focus.”
Researchers analyzed data from 270 children and adolescents aged 21 years and younger who were diagnosed with type 1 diabetes at UCSF Benioff Children’s Hospital from February 2015 to September 2021. Demographic data were collected for each youth. Participants were divided into a group of 159 children and adolescents initiating CGM less than 6 months after diagnosis, 83 participants who started CGM more than 6 months after diagnosis and 28 children and adolescents who never used CGM.
The group that began using CGM more than 6 months after diagnosis had a higher percentage of participants who were from a racial-ethnic minority group (47% vs. 28.9%; P < .001) and a higher proportion of participants with public insurance (57.8% vs. 30.2; P < .001) than children who began using CGM less than 6 months after diagnosis.
Children and adolescents with private insurance began CGM use 2 months after diagnosis compared with 6 months for those with public insurance (P < .001). For children and adolescents from racial-ethnic minority groups, mean time to CGM initiation was 5.19 months compared with 2.46 months for non-Hispanic white children and adolescents (P < .001).
Median HbA1c was higher in the group that initiated CGM more than 6 months after diagnosis than those starting CGM less than 6 months after diagnosis (8.4% vs. 7.5%; P < .001).
Borbjerg said her research team is planning to build on this analysis with future research with longitudinal data examining longer-term HbA1c changes among the study group. Future studies also plan to examine area deprivation index and other socioeconomic factors.
“We also have data when [children] discontinued the use of CGM,” Borbjerg said. “Some of the children stopped using CGM and we want to see which children discontinued and how that impacts HbA1c.”
Perspective
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In this study of 270 children with type 1 diabetes, the authors found that newly-diagnosed patients who began continuous glucose monitoring longer than 6 months from diagnosis had significantly higher HbA1c levels after follow-up. Longer time to CGM initiation was also observed among those from racial-ethnic minority groups compared to non-Hispanic whites and among patients with public insurance compared to those with private coverage.
This study is in line with previous publications which have demonstrated that CGM use is associated with lower HbA1c, extending this finding to the time around diabetes diagnosis. Further, this study also extends a growing acknowledgement of disparities in access to diabetes to technology based on social determinants of health. Notably, changes in CGM technology, insurance coverage and prescribing patterns during the study period (2015-2021) may partially explain these observations. However, the stark between group differences and consistency with previous data make this an important contribution to the landscape of disparities in diabetes technology use.
This study further emphasizes the need for future work to identify and mitigate the root causes of disparities in diabetes care to ensure that every person with type 1 diabetes has access to diabetes technology.
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Borbjerg MK, et al. 1910-LB. Presented at: American Diabetes Association Scientific Sessions; June 21-24, 2024; Orlando.
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