Impact of race and delayed adoption of diabetes technology on glycemia and partial remission in type 1 diabetes.

Abstract

Objectives: Continuous glucose monitors (CGM) are the mainstay of glucose monitoring in type 1 diabetes (T1D). However, the impact of race/ethnicity and the timing of CGM adoption following T1D diagnosis is unclear. We examined the effect of race/ethnicity and CGM adoption on glycemia and partial remission (PR) in T1D.

Methods: A 24-month longitudinal retrospective cohort study of youth with T1D who used Dexcom CGM G5/G6 between 2018 and 2022 was conducted. Subjects were classified as non-Hispanic White (NHW) or Other (Asian, Black/African American, Hispanic/Latino, or other). Glycemia was measured as %change in hemoglobin A1c (A1c) and time in range (TIR) from baseline to 24 months. PR was denoted as an insulin-dose-adjusted A1c (IDAA1c) value of ≤9. The statistical approach included the paired t-test, the Wilcoxon signed-rank test, and mixed effects models for repeated measures.

Results: Early CGM adoption occurred in 90 % (61/68) of NHW subjects vs. 63 % (43/68) of the Other, p=0.0003. Early CGM adoption was associated with improved glycemia and PR as marked by a significantly greater %decrease in A1c, p=0.0008, and IDAA1c, p=0.0003, at 24 months following CGM adoption. Temporal trends in A1c and IDAA1c were significantly lower among NHW subjects, p<0.0001, and the probability of PR was significantly greater, p<0.0001. Early CGM adoption conferred a greater probability of PR than late CGM adoption, p<0.0001.

Conclusions: Early adoption of diabetes technology should be accelerated in all children with T1D, particularly minority children, to reduce hyperglycemia, promote PR, and close the gap in diabetes care and complications in the United States.