Insulin pumps, continuous glucose monitors (CGMs) - over the past decade, the use of diabetes technologies to manage type 1 diabetes in children and adolescents has increased worldwide. Researchers at the DZD in Düsseldorf, Munich and Ulm, together with colleagues from the USA, have investigated whether inequality in access to these technologies based on socioeconomic status (SES) also leads to different levels of blood glucose (HbA1c). Their study, now published in Diabetes Care, shows " A decade of disparities in diabetes technology use and HbA1c in pediatric type 1 diabetes: A transatlantic Comparison".
For the study, researchers examined the use of diabetes technology and HbA1c levels in children and adolescents under 18 years of age from the Type 1 Diabetes Exchange (T1DX, USA, n = 16,457) and Diabetes Prospective Follow-up (DPV, Germany, n = 39,836) registries by socioeconomic status (SES) between two time periods 2010-2012 and 2016-2018. For this purpose, the registers were divided into quintiles. For categorisation into Q1 (lowest SES) to Q5 (highest SES), insurance type, education level and annual income, among others, were used.
The study showed that participants with lower SES had higher HbA1c (in 2010-2012 and 2016-2018, respectively: 8.0% and 7.8% in Q1 and 7.6% and 7.5% in Q5 for DPV; 9.0% and 9.3% in Q1 and 7.8% and 8.0% in Q5 for T1DX). For DPV, the association between SES and HbA1c did not change between the two time periods, whereas for T1DX, disparities in HbA1c by SES increased significantly (P < 0.001). After adjusting for technology use, results for DPV did not change, whereas the increase in T1DX was no longer significant.
Although no causal conclusions can be drawn, diabetes technology use is lowest and HbA1c is highest in those of the lowest SES quintile in the T1DX, and this difference for HbA1c broadened in the past decade. Associations of SES with technology use and HbA1c were weaker in the DPV registry.
Addala et al.: A Decade of Disparities in Diabetes Technology Use and HbA 1c in Pediatric Type 1 Diabetes: A Transatlantic Comparison. Diabetes Care (2020); DOI: 10.2337/dc20-0257