Use of CGM and insulin pumps is associated with lower HbA1c in patients with T1D, regardless of a user’s socioeconomic status, Australian data show.
The findings contradict some received wisdom about the impact of low income or other markers of disadvantage on use of diabetes technology and highlight the need to remove financial barriers to access, the researchers say.
Their cross-sectional analysis included HbA1c records from 2822 young Australian patients with T1D, whose residential postcodes were used to assign socioeconomic status, based on the Index of Relative Socio-Economic Disadvantage (IRSD).
Of the study cohort, 1025 (36%) were using both a pump and CGM, with a further 16% and 23% respectively using only either a pump or CGM. A further 25% were on insulin injections only.
Findings were that compared with this latter, pump use was associated with a 0.45% lower mean HbA1c, and CGM use (with insulin injections) with a 0.7% reduction.
Patients concurrently using a pump and CGM had the largest median HbA1c reduction at 1.24%.
But importantly, glycaemic outcomes were improved across all IRSD quintiles, with no interaction between technology use and socioeconomic status on HbA1c, the researchers reported in Diabetes Care (link here).
“While causality cannot be inferred, the primary study finding is that regardless of relative socioeconomic disadvantage, all groups demonstrated better glycaemic control with technology use,” they wrote.
“Barriers to technology access for those with greater socioeconomic disadvantage should be identified and addressed for the benefits of technology to be realised equitably.”
The findings added weight to calls for equitable access models to diabetes technology in Australia and elsewhere, added the team, led by clinicians from Perth Children’s Hospital and University of Western Australia.
“The glycaemic benefit of diabetes technologies observed was similar across all socioeconomic quintiles and was greatest with concurrent use of pump and CGM.”
“With rapidly accumulating evidence from trial and real-world settings that technology including AID improves glycaemic control for youth with T1D, it is paramount that efforts are made to prioritize equitable access to diabetes technology for youth with T1D of all backgrounds.”
This was not yet the case in Australia, despite the creation of a national subsidy in 2017 enabling broad access to CGM for young patients with T1D, the authors said.
In particular, those patients with the greatest levels of disadvantage still had lower levels of CGM use and pumps were primarily self-funded or accessed through private health insurance, they noted.
“Philanthropy provides limited additional access to those with socioeconomic disadvantage, but barriers to pump therapy access persist,” they wrote.
“Global analyses have outlined similar inequities in funding models for diabetes technology.”
“Results from our analysis suggest that improving technology access may improve glycaemic outcomes for youth with T1D, regardless of socioeconomic background.”