Disparities in Time to Technology Initiation in the Year Following Diagnosis of Type 1 Diabetes among Youth: A Retrospective Cohort Study.

Background: Despite rapidly evolving diabetes technology and evidence that early access to technologies improves outcomes, there is disparate use based on socio-demographic factors. We sought to characterize technology uptake in the year following diagnosis of type 1 diabetes in youth based on race/ethnicity, insurance, and household structure.

Methods: We conducted a retrospective cohort study of 692 youth diagnosed with and treated for type 1 diabetes between 2016 and 2020 at a children's hospital. Medical record review provided outcomes of interest, including time to initiation of continuous glucose monitors (CGMs), insulin pump therapy, or both. We used cumulative incidence curves and competing risks regression to compare time to initiation by socio-demographic groups.

Results: There were 692 youth, 59% male, diagnosed at a mean age of 10.8 (±4.2) years, in the sample. The majority (83.2%) were White, English-speaking (94.4%), and privately insured (76.7%), with 71.7% living in two-parent households. Cumulative incidence curves and competing risks regression showed that publicly insured youth had a lower likelihood of starting diabetes technologies in the year following diagnosis than privately insured youth. Black and Hispanic youth were less likely than white youth to start CGM and insulin pumps. Youth from non-intact households similarly exhibited lower rates of technology uptake. Hazard ratios for time to both technologies were comparable to those for time to insulin pump.

Conclusions: These findings highlight the importance of developing interventions to advance diabetes technology use from onset of type 1 diabetes for all youth.