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Addala does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.
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According to a study published in Diabetes Care, socioeconomic disparities in the use of diabetes technology and HbA1c in children in the United States widened in 2016-2018 compared to 2010-2012.
The researchers assessed socio-economic differences in the use of diabetes technology and HbA1c among adolescents in the United States and Germany. Although differences were observed in both countries between 2010 and 2012, the differences in the US worsened between 2016 and 2018 and were more pronounced than among German children.
The socioeconomic disparities in the use of CGM in the US widened from 2010-2012 to 2016-2018. Data was derived from Addala A et al. Diabetes treatment. 2021; doi: 10.2337 / dc20-0257.
“The takeaway message from this work is a call to action to prioritize equitable access to diabetes care in America.” Ananta Addala, DO, MPH, an instructor in the Department of Pediatric Endocrine and Diabetes at Stanford University, said Healio. “In this study, we report that the differences in the use of diabetes technology and HbA1c by socioeconomic status have worsened over the past decade for the poorest youth in America. We have found that the use of diabetes technology is the major contributor to this HbA1c deterioration seen in America. “
Ananta Addala
Addala and colleagues analyzed data from 16,457 adolescents in the United States with type 1 diabetes who had data registered on the type 1 diabetes exchange and from 39,836 German children with diabetes who were enrolled in the Diabetes Prospective Follow-up . Data from the period 2010-2012 or 2016-2018 were available to all participants. Insurance type, educational level and annual income were used to divide participants into socio-economic status quintile groups. The first quintile included those with the lowest socio-economic status and the fifth quintile included participants with the highest socio-economic status.
The differences in the use of US diabetes technology are increasing
Both the use of insulin pumps and the continuous use of glucose monitors increased in the US and Germany from 2010-2012 to 2016-2018. In German children, insulin pump consumption rose from 53.8% in the lowest quintile to 57% in the fourth quintile, before falling to 49.1% in the highest quintile from 2010 to 2012 (P = 0.002). A similar pattern was observed in 2016-2018. In the US, the prevalence of insulin pump use between 2010 and 2012 was 28.6% for the lowest quintile and 70.3% for the highest quintile (P <0.001). In 2016-2018, 36.5% of adolescents in the lowest quintile used an insulin pump and 75.8% in the highest quintile used an insulin pump (P <0.001).
In Germany, the CGM consumption between 2010 and 2012 was 5.7% in the lowest quintile and 3.8% in the highest quintile (P = 0.004). In 2016-2018, the lowest quintile had a CGM prevalence of 48.5% and 57.1% in the highest quintile had a CGM (P <0.001). In the US, 2.9% in the lowest quintile and 11% in the highest used a CGM from 2010 to 2012 (P <0.001). The gap widened in 2016-2018 to 15% in the first quintile using a CGM versus 52.3% in the fifth quintile (P <0.001).
Larger HbA1c differences in the USA than in Germany
In Germany, the lowest quintile 2010-2012 had a mean HbA1c value of 8% and the highest quintile a mean HbA1c value of 7.6% (P <0.001). In the years 2016-2018, the mean HbA1c value decreased to 7.8% in the lowest quintile and to 7.5% in the highest quintile (P <0.001).
In the United States, the mean HbA1c for the lowest quintile was 9% from 2010 to 2012 and 7.8% for the highest (P <0.001). The gap widened in 2016-2018, with the lowest quintile having a mean HbA1c value of 9.3% and the lowest having a mean HbA1c value of 8% (P <0.001).
For German adolescents, the relationship between socio-economic status and HbA1c did not change significantly between the two periods, while the socio-economic differences between US children changed significantly. Although HbA1c increased in all socioeconomic quintiles in the US, there were larger increases in the lower quintiles between the two periods (P = 0.0005). The increase in HbA1c was no longer significant after adjusting the insulin pump and CGM use.
“We expected that there would be differences in socioeconomic status in both America and Germany, but we were surprised and disillusioned that the differences had actually worsened in America over the past decade,” said Addala. “We found it interesting that there was no connection between diabetes technology and socio-economic status in German adolescents.”
Addala said the results show how improved access to diabetes technology could be a step towards narrowing the disparities for teenagers in the United States
“Prioritizing equitable access to diabetes technology for all adolescents seems like a clear strategy to at least reverse the trend of worsening diabetes outcomes,” Addala said. “It’s important to note that improving access to diabetes technology is one step in removing disparities, but it shouldn’t be the only one. There is a growing body of literature to suggest that factors not directly related to diabetes, such as systemic racism or provider bias, are important in achieving equitable diabetes outcomes. “
Addala said future studies are needed to examine drivers of disparities in the use of diabetes technology for children to improve outcomes.
For more informations:
Ananta Addala, DO, MPHcan be reached at addala@stanford.edu; Twitter: @DrAAddala
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