Social disadvantage and technology use among adults with type 1 diabetes in Quebec: A cross-sectional study using data from the Canadian T1D (BETTER) Registry.

Abstract

Aims: We evaluated associations between social disadvantage and insulin pump and continuous glucose monitor (CGM) use among adults with type 1 diabetes (T1D) in Quebec, Canada, where public funding is available for CGM but not for insulin pumps.

Materials and methods: We conducted a cross-sectional analysis using self-reported survey data collected from April 2019 to October 2023. Primary exposures were social disadvantage indicators (Race, income, education, employment, insurance, immigration, rural/urban location). Primary outcomes were insulin pump and CGM use. Logistic regression was used to assess associations between social disadvantage indicators and the odds of insulin pump and CGM use.

Results: Among 2380 adults with T1D, 37.4% used insulin pumps and 82.5% used CGM. Insulin pump use was lower among those with income <$80 000 (odds ratio [OR] 0.64 [95% confidence interval 0.50-0.82]), no post-secondary education (OR 0.62 [0.46-0.85]), non-White Race (OR 0.47 [0.30-0.73]) and public insurance (OR 0.47 [0.35-0.62]). CGM use was lower only among those with income <$80 000 (OR 0.61 [0.45-0.83]) and public insurance (OR 0.61 [0.45-0.83]). Odds of insulin pump and CGM use were successively lower with an increasing number of social disadvantage indicators. Insulin pump and CGM use were both associated with lower HbA1c but not severe hypoglycaemia or diabetes hospitalisation.

Conclusions: Social disadvantage is associated with lower uptake of insulin pumps and CGM among Quebec adults with T1D, though public funding partially mitigates disparities in CGM use. Given the benefits and increasing recommendations for automated insulin delivery, strategies to increase the uptake of diabetes technologies among socially disadvantaged individuals are required.

Plain language summary: Social disadvantage is linked to lower use of insulin pumps and CGM in adults with T1D in Quebec. Public funding narrows CGM disparities, but broader equity strategies are needed.