Minority Children, Publicly Insured with T1D Experience Delays in CGM Access

Mette Borbjerg, MD
Credit: American Diabetes Association

Data presented at the 84th American Diabetes Association Scientific Sessions underline the need for more equitable access and prescription of diabetes technology in the US.

A study of more than 250 children and adolescents with type 1 diabetes, results of the study indicate publicly insured children and children of minority groups experience delays in starting recommended type 1 diabetes treatment with continuous glucose monitoring (CGM) technology than their counterparts with private insurance or from non-Hispanic White families.¹

“Our results highlight the marked difference in HbA1c in children that receive CGM early on,” said principal investigator Mette K. Borbjerg, MD, of the Steno Diabetes Center North Denmark and Division of Pediatric Endocrinology at the University of California San Francisco (UCSF).² “Ensuring timely CGM access for all children is essential to reduce complication risks. This highlights the need for practices and policies to address barriers to CGM initiation and healthcare access.”

Since the turn of the century, study after study has come forth detailing the benefits of early initiation of diabetes technology, particularly CGM, in the management of type 1 diabetes. This advancement in understanding of the role of CGM has led to the ADA 2023 Standards of Care recommending CGM should be offered to youth and adults with type 1 and type 2 diabetes on intensive insulin therapy or continuous subcutaneous insulin infusion who are able to use the devices safely.^1,3

In the current study, Borbjerg and colleagues sought to better understand how insurance type and race/ethnicity might influence the rate of CGM initiation in children with type 1 diabetes and to compare glycemic control in those initiating CGM within six months of diagnosis compared to later initiation. With this in mind, investigators designed their study as ana analysis of data from individuals up to age 21 years who received a diagnosis of type 1 diabetes from February 2015 and September 2021 and received care at UCSF Benioff Children’s Hospital.¹

In total, 270 individuals were identified for inclusion in the study. Of these, 159 initiated CGM less than 6 months after diagnosis, 83 initiated 6 months or more after diagnosis, and 28 received no CGM.¹

Investigators noted analysis of insurance and race/ethnicity was performed using one-way ANOVA or Kruskal Wallis H-test and comparison of early and late CGM initiation was performed using the T-test and Wilcoxon test.¹

Upon analysis, results indicated the median time from type 1 diabetes diagnosis to CGM initiation was 6.19 months for publicly insured individuals compared to 2.23 months for privately insured individuals (P <.001). Additionally, similar differences were found between individuals of racial or ethnic minority groups and individuals identified as non-Hispanic White, with minority groups experiencing a median time to CGM initiation of 5.19 months relative to 2.46 months among non-Hispanic White children (P <.001). Further analysis demonstrated those with early CGM initiation had a median HbA1c of 7.5% (5.0 to 14.1) compared to 8.4% (5.40 to 14.1) for those who initiated after the 6-month mark (P <.001).¹

“People with type 1 diabetes are at a heightened risk for health complications as they age. They all deserve access to care and treatment, no matter their no matter their race, income, ZIP Code, age, education, or gender,” said Robert Gabbay, MD, PhD, chief scientific and medical officer.² “The findings from the studies presented at this year's Scientific Sessions are encouraging, as we strive to develop innovative, evidence-based solutions to support a diverse population of people living with diabetes and maintain their care.”

References:

1. ^{BORBJERG M, KVIST AV, MEHTA K, EJSKJAER N, WONG JC. Disparities in Initiation of Continuous Glucose Monitoring and Impact on Glycemic Control in Children and Adolescents with Type 1 Diabetes. Presented at: American Diabetes Association (ADA) 84th Scientific Sessions. June 21 - 24, 2024. Orlando, FL.}
2. ^{American Diabetes Association. New research indicates the need for diabetes continuous glucose monitoring to address health disparities. New Research Indicates the Need for Diabetes Continuous Glucose Monitoring to Address Health Disparities | ADA. June 21, 2024. Accessed June 22, 2024. https://diabetes.org/newsroom/press-releases/new-research-indicates-need-diabetes-continuous-glucose-monitoring-address.}
3. ^{Friedman JG, Cardona Matos Z, Szmuilowicz ED, Aleppo G. Use of Continuous Glucose Monitors to Manage Type 1 Diabetes Mellitus: Progress, Challenges, and Recommendations. Pharmgenomics Pers Med. 2023;16:263-276. Published 2023 Mar 31. doi:10.2147/PGPM.S374663}