Evaluating Factors Associated With Continuous Glucose Monitoring Utilization With the Type 1 Diabetes Exchange Registry

Abstract

Background: The 2022 American Diabetes Association (ADA) Standards of Care recommends considering use of continuous glucose monitoring (CGM) for insulin-managed diabetes mellitus (DM), but equitable access remains challenging. This study evaluates socioeconomic and demographic metrics associated with CGM use. Methods: RStudio 2021.09.1+372 was utilized to perform uni- and bivariable analysis, as well as binomial logistic regression modeling for categorical CGM use (yes/no) on the most recent cross-section from the Type 1 Diabetes Exchange (T1DX) Registry 2016-2018 cohort ( n = 22 418). Results: Compared with White Non-Hispanic participants, Black Non-Hispanic (OR = 0.45, CI = 0.36-0.57, P < 0.001) and American Indian/Alaskan Native individuals (OR = 0.33, CI = 0.14-0.70, P = 0.008) had lower odds of CGM use. Compared with private insurance, government insurance had reduced odds of CGM use (OR = 0.59, CI = 0.52-0.66, P < 0.001). Individuals earning $100,000 or more were twice as likely to use CGMs (OR = 2.06, CI = 1.75-2.45, P < 0.001) compared with those earning <$25,000 annually. Subgroup analysis based on income bracket demonstrated that government insured individuals earning <$25,000 annually were the least likely to use CGMs (OR = 0.44, CI = 0.32-0.61, P < 0.001), as compared with private insurance. Conclusions: T1DX Registry data demonstrate that CGM use follows the inverse care law, with health technology utilization inversely related to disease burden. Federal policies promoting CGM use in Medicare and Medicaid populations can facilitate the ADA’s recommendation for patients with insulin-managed diabetes mellitus.

Socio‐economic disparities in hospital care among Dutch patients with diabetes mellitus

“…Similarly, associations between SES and diabetic ketoacidosis, glycaemic control and hypoglycaemia have previously been described 30 . Regarding adults, recent studies from the USA have reported lower CSII and CGM use in patients of all ages with lower SES or less generous insurance 13,14,31 . In New Zealand lower SES was also associated with lower CSII use in patients of all ages 12 .…”

“…30 Regarding adults, recent studies from the USA have reported lower CSII and CGM use in patients of all ages with lower SES or less generous insurance. 13,14,31 In New Zealand lower SES was also associated with lower CSII use in patients of all ages. 12 Moreover, a study from the United Kingdom evaluated the use of diabetes technology in adults and found less frequent use in participants from the most deprived neighbourhoods.…”

“…9,10 Use of diabetes technology, such as continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM), is, apart from reimbursement policies, also influenced by SES-related factors at all ages. 9,[11][12][13][14] Targets for cardiometabolic risk factors are less often met, and life expectancy and years spent without complications are lower than in those living without diabetes. 15,16 In the Netherlands, most studies related to SES and diabetes focus on type 2 diabetes.…”

“…Focusing on type 1 diabetes, SES influences glycaemic control in both children and adults 9,10 . Use of diabetes technology, such as continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM), is, apart from reimbursement policies, also influenced by SES‐related factors at all ages 9,11–14 . Targets for cardiometabolic risk factors are less often met, and life expectancy and years spent without complications are lower than in those living without diabetes 15,16 .…”

The impact of socioeconomic factors, social determinants, and ethnicity on the utilization of glucose sensor technology among persons with diabetes mellitus: a narrative review

“…A relationship between income, which is closely related to occupational status, and CGM use has often been reported, from the introduction of CGM devices, 56 to the present day, 58 in which those in high-income groups (>$100.000 annually) are twice as likely to use a CGM than those in low-income groups (<$25,000 annually). Similar patterns have been found across all ages 59 and cost is the most often cited barrier to the use of CGMs, by both patients 60 and providers, 61 in the USA and abroad.…”