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June 23, 2024
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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.
Perspective from Daniel R. Tilden, MD, MPH

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.

Diabetes glucose meter check_Adobe
Youths from racial-ethnic minority groups and those with public insurance took longer to start CGM after type 1 diabetes diagnosis. Image: Adobe Stock.

“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.

Mette K. Borbjerg

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.”