1910-LB: Disparities in Initiation of Continuous Glucose Monitoring and Impact on Glycemic Control in Children and Adolescents with Type 1 Diabetes

Abstract

Introduction & Objective: The American Diabetes Association recommends continuous glucose monitoring (CGM) for all people with type 1 diabetes (T1D) as early as the time of diagnosis. CGM has been associated with reductions in HbA1c, and it has been recommended that CGM should be initiated within 12 months of diagnosis. We aimed to determine the impact of insurance and race/ethnicity on the timing of CGM initiation in children with T1D and to compare glycemic control in those initiating CGM within six months of diagnosis compared to later initiation. Methods: Children up to age 21 years followed at UCSF Benioff Children’s Hospital diagnosed with T1D between February 2015 and September 2021 were included (n = 270) and grouped according to time of CGM initiation. Analysis of insurance and race/ethnicity was done using one-way ANOVA or Kruskal Wallis H-test. T-test and Wilcoxon test were performed to compare early and late CGM initiation. Results: The median time from T1D diagnosis to CGM initiation was 6 months for publicly insured individuals compared to 2 months for privately insured individuals (p-value < 0.001), similar differences were found between individuals of racial or ethnic minority (minority) groups and individuals identified as white, non-Hispanic. Median HbA1c was 7.5% for children with time-of-initiation < 6 months; 8.4% for children with time-of-initiation > 6 months (p-value < 0.001). Conclusion: Publicly insured children and children of minority groups experience delays in starting recommended T1D treatment with CGM, with a longer time-to-initiation as compared to privately insured children and white, non-Hispanic children. This is of clinical importance, as more optimal glycemic control has been associated with earlier initiation of CGM. Barriers to CGM initiation may result in less optimal glycemic control for publicly insured children and children of minority groups with diabetes. Disclosure M. Borbjerg: None. K. Mehta: None. N. Ejskjaer: None. J.C. Wong: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Abbott.