Inequity in access to continuous glucose monitoring and health outcomes in paediatric diabetes, a case for national continuous glucose monitoring funding: a cross-sectional population study of children with type 1 diabetes in New Zealand

Burnside, Mercedes; Williman, Jonathan; Davies, Hannah M.; Jefferies, Craig; Paul, Ryan; Wheeler, Benjamin J; Wiltshire, Esko; Anderson, Yvonne; Bock, Martin

doi:10.1016/j.lanwpc.2022.100644

Cited by 22 publications

(25 citation statements)

References 24 publications

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“…previous study has shown that rtCGM can reduce inequities glucose outcomes based on socio-economic status or ethnicity, 31 and therefore a lower cost DIY-CGM has a role as an interim measure while advocacy to improve access for all to rtCGM continues.…”

Section: Discussionmentioning

confidence: 99%

“…As long as isCGM remains cheaper than most commercial rt‐CGM, DIY‐CGM has the potential to increase access to rtCGM use, especially if more clinicians and nurse specialists became familiar with its use. A previous study has shown that rtCGM can reduce inequities in glucose outcomes based on socio‐economic status or ethnicity, 31 and therefore a lower cost DIY‐CGM has a role as an interim measure while advocacy to improve access for all to rtCGM continues.…”

Section: Discussionmentioning

confidence: 99%

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Do‐it‐yourself continuous glucose monitoring in people aged 16 to 69 years with type 1 diabetes: A qualitative study

et al. 2023

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AimsIn many countries, real‐time continuous glucose monitoring (rt‐CGM) is not funded, and cost presents a barrier to access. A do‐it‐yourself conversion of intermittently scanned CGM (DIY‐CGM) is a cheaper alternative. This qualitative study aimed to explore user experiences with DIY‐CGM in people aged 16 to 69 years with type 1 diabetes (T1D).MethodsConvenience sampling was used to recruit participants for semi‐structured virtual interviews exploring experiences of DIY‐CGM use. Participants were recruited after completing the intervention arm of a crossover randomised controlled trial that evaluated DIY‐CGM versus intermittently scanned CGM (isCGM). Participants were previously naive to DIY‐CGM and rt‐CGM but not isCGM. The DIY‐CGM intervention consisted of a Bluetooth bridge connected to isCGM, adding rt‐CGM functionality over 8 weeks. Interviews were transcribed, then thematic analysis was performed.ResultsInterviews were with 12 people aged 16 to 65 years, with T1D: mean age ± SD 43 ± 14 years; baseline mean HbA1c ± SD 60 mmol/mol ± 9.9 (7.6 ± 0.9%) and time in range 59.8% ± 14.8%. Participants perceived that using DIY‐CGM improved both glycaemic control and aspects of quality of life. Alarm and trend functionality allowed participants to perceive reduced glycaemic variability overnight and following meals. The addition of a smartwatch increased discrete access to glucose information. There was a high degree of trust in DIY‐CGM. Challenges while using DIY‐CGM included signal loss during vigorous exercise, alarm fatigue and short battery life.ConclusionsThis study suggests that for users, DIY‐CGM appears to be an acceptable alternative method of rt‐CGM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Do‐it‐yourself continuous glucose monitoring in people aged 16 to 69 years with type 1 diabetes: A qualitative study

et al. 2023

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“…efficacy of all these systems, it isCGM or rtCGM, a key issue globally remains the equity of access for people living with diabetes. 30 The strength of this meta-analysis is the comprehensive systematic literature review which examined various clinical aspects and demographic characteristics across RCTs comparing the efficacy of two divergent CGM types. Notably, the analysis of the primary TIR outcome showed moderate heterogeneity, providing further reliability to the results.…”

Section: Discussionmentioning

confidence: 99%

“…This potentially means standalone isCGM in all forms will have less clinical relevance into the future, with potentially less importance given to conducting further head‐to‐head trials. Given the known efficacy of all these systems, whether it is isCGM or rtCGM, a key issue globally remains the equity of access for people living with diabetes 30 …”

Section: Discussionmentioning

confidence: 99%

Comparing the glycaemic outcomes between real‐time continuous glucose monitoring (rt‐CGM) and intermittently scanned continuous glucose monitoring (isCGM) among adults and children with type 1 diabetes: A systematic review and meta‐analysis of randomized controlled trials

Zhou,

Sardana,

Kuroko

et al. 2024

Diabet Med

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AimTo conduct a systematic review and meta‐analysis of randomized controlled trials (RCTs) comparing the effectiveness of real‐time continuous glucose monitoring (rtCGM) versus intermittently scanned continuous glucose monitoring (isCGM) on key glycaemic metrics (co‐primary outcomes HbA1c and time‐in‐range [TIR] 70–180 mg/dL, 3.9–10.0 mmol/L) among people with type 1 diabetes (T1D).MethodsMedline, PubMed, Scopus, Web of Science and Cochrane Central Register of clinical trials were searched. Inclusion criteria were RCTs; T1D populations of any age and insulin regimen; comparing any type of rtCGM with isCGM (only the first generation had been compared to date); and reporting the glycaemic outcomes. Glycaemic outcomes were extracted post‐intervention and expressed as mean differences and 95% CIs between the two comparators. Results were pooled using a random‐effect meta‐analysis. The risk of bias was assessed using the Cochrane RoB2 tool. The quality of evidence was assessed by the GRADE approach.ResultsFive RCTs met the inclusion criteria (4 parallel and 1 crossover design; 4 with CGM use <8 weeks), involving 446 participants (354 adults; 92 children and adolescents). Overall, meta‐analysis showed rtCGM compared to isCGM improved absolute TIR by +7.0% (95% CI: 5.8%–8.3%, I2 = 0%, p < 0.01) accompanied by a favorable effect on time‐below‐range <70 mg/dL (3.9 mmol/L) – 1.7% (95%CI: −3.0% to −0.4%; p = 0.03). No differences were seen regarding HbA1c.ConclusionsThis meta‐analysis highlights that for people with T1D, rtCGM confers benefits over isCGM primarily related to increased TIR, with improvements in hypo‐ and hyperglycaemia.

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“…Continuous glucose monitoring (CGM), another important diabetes technology proven to improve glycaemia [ 17 ], is not funded in New Zealand, either publicly or through health insurance. Burnside et al [ 18 ] found CGM use is highest amongst NZE, and universal access to CGM is one way to reduce inequities in glycaemic outcomes between ethnic groups.…”

Section: Introductionmentioning

confidence: 99%

Interviews with Indigenous Māori with type 1 diabetes using open-source automated insulin delivery in the CREATE randomised trial

Burnside

Haitana

Crocket

et al. 2023

J Diabetes Metab Disord

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Purpose Open-source automated insulin delivery (AID) is used by thousands of people with type 1 diabetes (T1D), but has unknown generalisability to marginalised ethnic groups. This study explored experiences of Indigenous Māori participants in the CREATE trial with use of an open-source AID system to identify enablers/barriers to health equity. Methods The CREATE randomised trial compared open-source AID (OpenAPS algorithm on an Android phone with a Bluetooth-connected pump) to sensor-augmented pump therapy. Kaupapa Māori Research methodology was used in this sub-study. Ten semi-structured interviews with Māori participants (5 children, 5 adults) and whānau (extended family) were completed. Interviews were recorded and transcribed, and data were analysed thematically. NVivo was used for descriptive and pattern coding. Results Enablers/barriers to equity aligned with four themes: access (to diabetes technologies), training/support, operation (of open-source AID), and outcomes. Participants described a sense of empowerment, and improved quality of life, wellbeing, and glycaemia. Parents felt reassured by the system’s ability to control glucose, and children were granted greater independence. Participants were able to use the open-source AID system with ease to suit whānau needs, and technical problems were manageable with healthcare professional support. All participants identified structures in the health system precluding equitable utilisation of diabetes technologies for Māori. Conclusion Māori experienced open-source AID positively, and aspired to use this therapy; however, structural and socio-economic barriers to equity were identified. This research proposes strength-based solutions which should be considered in the redesign of diabetes services to improve health outcomes for Māori with T1D. Trial Registration: The CREATE trial, encompassing this qualitative sub-study, was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000034932p) on the 20th January 2020.

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Inequity in access to continuous glucose monitoring and health outcomes in paediatric diabetes, a case for national continuous glucose monitoring funding: a cross-sectional population study of children with type 1 diabetes in New Zealand

Cited by 22 publications

References 24 publications

Do‐it‐yourself continuous glucose monitoring in people aged 16 to 69 years with type 1 diabetes: A qualitative study

Do‐it‐yourself continuous glucose monitoring in people aged 16 to 69 years with type 1 diabetes: A qualitative study

Comparing the glycaemic outcomes between real‐time continuous glucose monitoring (rt‐CGM) and intermittently scanned continuous glucose monitoring (isCGM) among adults and children with type 1 diabetes: A systematic review and meta‐analysis of randomized controlled trials

Interviews with Indigenous Māori with type 1 diabetes using open-source automated insulin delivery in the CREATE randomised trial

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