Findings Highlight the Impact of Insurance Barriers on Managed Diabetes Care for Diverse Populations Living with Type 1 Diabetes
Results from a new study show the impact and importance of continuous glucose monitoring (CGM) that young individuals with diabetes face today. The findings were presented as a Late-Breaking Poster at the 84th Scientific Sessions of the American Diabetes Association® (ADA) in Orlando, FL.
Health disparities is a growing concern that significantly impacts diabetes. In nearly all states, those who identify as Black and Native American are more likely than those who identify as Asian American, Hispanic/Latino, and White to die from complications of diabetes. Over half of Hispanic/Latino adults are predicted to develop type 2 diabetes during their lives.
“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, ADA chief scientific and medical officer. “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.”
The use of CGM reduces HbA1c and is recommended by the American Diabetes Association within 12 months of a type 1 diabetes diagnosis. This study examines the impact of insurance, race, and ethnicity on the timing of CGM initiation in children with type 1 diabetes and compares glycemic control between those who start CGM within six months of diagnosis versus later.
Children up to age 21 diagnosed with T1D at UCSF Benioff Children’s Hospitals between February 2015 and September 2021 (n = 270) were grouped by CGM initiation time. Insurance, race, and ethnicity were analyzed using one-way ANOVA (Kruskal-Wallis H-test) to determine if samples originated from the same distribution. T-tests and Wilcoxon tests compared early and late CGM initiation. Data normality was assessed with QQ plots and density plots.
Results showed that on average publicly insured children started CGM within six months, while privately insured children started CGM within two months. Similar delays were observed for children from historically marginalized racial or ethnic groups compared to White, non-Latinx children. The average HbA1c was 7.5% for children who started CGM within six months of diagnosis, compared to 8.4% for those who started later. Barriers to CGM initiation contribute to less optimal glycemic control for publicly insured and racially and ethnically minoritized children, increasing the risk of complications. Addressing these disparities could improve early blood sugar control and health outcomes.
“Our results highlight the marked difference in HbA1c in children that receive CGM early on,” said Mette K Borbjerg, lead author from the Steno Diabetes Center North Denmark and Division of Pediatric Endocrinology, University of California San Francisco. Dr. Borbjerg’s co-authors include Annika Kvist (Steno Diabetes Center North Denmark), Kala Mehta (Department of Epidemiology, University of California San Francisco), Niels Ejskjaer (Steno Diabetes Center North Denmark and Department of Internal Medicine and Endocrinology, Aalborg University Hospital), and senior author Jenise Wong (Division of Pediatric Endocrinology, University of California San Francisco).nsuring timely CGM access for all children is essential to reduce complication risks.his highlights the need for practices and policies to address barriers to CGM initiation and healthcare access.”
Future research should focus on understanding the specific barriers preventing timely CGM initiation. A follow-up study assessing long-term health care outcomes in children with early vs late CGM initiation could provide evidence to advocate for policy changes.
Research presentation details:
Dr. Borbjerg will present the findings at the following Late- Breaking poster session:
- Disparities in Initiation of Continuous Glucose Monitoring and Impact on Glycemic Control in Children and Adolescents with Type 1 Diabetes
- Session: Saturday, June 22, 2024 from 12:30-1:00 PM EDT
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About the ADA’s Scientific Sessions
The ADA's 84th Scientific Sessions, the world's largest scientific meeting focused on diabetes research, prevention, and care, will be held in Orlando, FL on June 21-24. More than 11,000 leading physicians, scientists, and health care professionals from around the world are expected to convene both in person and virtually to unveil cutting-edge research, treatment recommendations, and advances toward a cure for diabetes. Attendees will receive exclusive access to thousands of original research presentations and take part in provocative and engaging exchanges with leading diabetes experts. Join the Scientific Sessions conversation on social media using #ADAScientificSessions.
About the American Diabetes Association
The American Diabetes Association (ADA) is the nation’s leading voluntary health organization fighting to bend the curve on the diabetes epidemic and help people living with diabetes thrive. For 83 years, the ADA has driven discovery and research to treat, manage, and prevent diabetes while working relentlessly for a cure. Through advocacy, program development, and education we aim to improve the quality of life for the over 136 million Americans living with diabetes or prediabetes. Diabetes has brought us together. What we do next will make us Connected for Life®. To learn more or to get involved, visit us at diabetes.org or call 1-800-DIABETES (1-800-342-2383). Join the fight with us on Facebook (American Diabetes Association), Spanish Facebook (Asociación Americana de la Diabetes), LinkedIn (American Diabetes Association), Twitter (@AmDiabetesAssn), and Instagram (@AmDiabetesAssn).
