Disparities in Hemoglobin A1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring
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Published:2023-04-19
Issue:4
Volume:6
Page:e238881
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Addala Ananta1, Ding Victoria2, Zaharieva Dessi P.1, Bishop Franziska K.1, Adams Alyce S.1345, King Abby C.36, Johari Ramesh7, Scheinker David1578, Hood Korey K.15, Desai Manisha2, Maahs David M.135, Prahalad Priya15, Arrizon-Ruiz Nora9, Pang Erica9, Cortes Ana9, Bonilla-Ospina Andrea9, Tam Rachel9, Balistreri Ilenia9, Loyola Alondra9, Alramahi Noor9, Frank Eliana9, Leverenz Jeannine9, Sagan Piper9, Martinex-Singh Anjoli9, Chmielewski Annette9, Conrad Barry9, Clash Kim9, Senaldi Julie9, Tanenbaum Molly9, Senanayake Ransalu9, Pei Ryan9, Osmanlliu Esli9, Chang Annie9, Dupenloup Paul9, Kurtzig Jamie9, Ritter Victor9, Shaw Blake9, Fox Emily9, Guestrin Carlos9, Ferstad Johannes9, Langlios Juan9, Wang Alex9, Futoma Josesph9, Levine Matthew9, Singhal Arpita9, Jeong Yujin9, McKay Matthew9, Pageler Nataglie9, Ghuman Simrat9, Wiedmann Michelle9, Brown Connor9, Watkins Bredan9, Loving Glenn9, Naranjo Diana9,
Affiliation:
1. Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California 2. Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, California 3. Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California 4. Department of Health Policy, Stanford University School of Medicine, Stanford, California 5. Stanford Diabetes Research Center, Stanford University, Stanford, California 6. Stanford Prevention Research Center Division, Department of Medicine, Stanford University School of Medicine, Stanford, California 7. Clinical Excellence Research Center, Stanford University, Stanford, California 8. Department of Management Science and Engineering, Stanford University, Stanford, California 9. for the Teamwork, Targets, Technology, and Tight Control (4T) Study Group
Abstract
ImportanceContinuous glucose monitoring (CGM) is associated with improvements in hemoglobin A1c (HbA1c) in youths with type 1 diabetes (T1D); however, youths from minoritized racial and ethnic groups and those with public insurance face greater barriers to CGM access. Early initiation of and access to CGM may reduce disparities in CGM uptake and improve diabetes outcomes.ObjectiveTo determine whether HbA1c decreases differed by ethnicity and insurance status among a cohort of youths newly diagnosed with T1D and provided CGM.Design, Setting, and ParticipantsThis cohort study used data from the Teamwork, Targets, Technology, and Tight Control (4T) study, a clinical research program that aims to initiate CGM within 1 month of T1D diagnosis. All youths with new-onset T1D diagnosed between July 25, 2018, and June 15, 2020, at Stanford Children’s Hospital, a single-site, freestanding children’s hospital in California, were approached to enroll in the Pilot-4T study and were followed for 12 months. Data analysis was performed and completed on June 3, 2022.ExposuresAll eligible participants were offered CGM within 1 month of diabetes diagnosis.Main Outcomes and MeasuresTo assess HbA1c change over the study period, analyses were stratified by ethnicity (Hispanic vs non-Hispanic) or insurance status (public vs private) to compare the Pilot-4T cohort with a historical cohort of 272 youths diagnosed with T1D between June 1, 2014, and December 28, 2016.ResultsThe Pilot-4T cohort comprised 135 youths, with a median age of 9.7 years (IQR, 6.8-12.7 years) at diagnosis. There were 71 boys (52.6%) and 64 girls (47.4%). Based on self-report, participants’ race was categorized as Asian or Pacific Islander (19 [14.1%]), White (62 [45.9%]), or other race (39 [28.9%]); race was missing or not reported for 15 participants (11.1%). Participants also self-reported their ethnicity as Hispanic (29 [21.5%]) or non-Hispanic (92 [68.1%]). A total of 104 participants (77.0%) had private insurance and 31 (23.0%) had public insurance. Compared with the historical cohort, similar reductions in HbA1c at 6, 9, and 12 months postdiagnosis were observed for Hispanic individuals (estimated difference, −0.26% [95% CI, −1.05% to 0.43%], −0.60% [−1.46% to 0.21%], and −0.15% [−1.48% to 0.80%]) and non-Hispanic individuals (estimated difference, −0.27% [95% CI, −0.62% to 0.10%], −0.50% [−0.81% to −0.11%], and −0.47% [−0.91% to 0.06%]) in the Pilot-4T cohort. Similar reductions in HbA1c at 6, 9, and 12 months postdiagnosis were also observed for publicly insured individuals (estimated difference, −0.52% [95% CI, −1.22% to 0.15%], −0.38% [−1.26% to 0.33%], and −0.57% [−2.08% to 0.74%]) and privately insured individuals (estimated difference, −0.34% [95% CI, −0.67% to 0.03%], −0.57% [−0.85% to −0.26%], and −0.43% [−0.85% to 0.01%]) in the Pilot-4T cohort. Hispanic youths in the Pilot-4T cohort had higher HbA1c at 6, 9, and 12 months postdiagnosis than non-Hispanic youths (estimated difference, 0.28% [95% CI, −0.46% to 0.86%], 0.63% [0.02% to 1.20%], and 1.39% [0.37% to 1.96%]), as did publicly insured youths compared with privately insured youths (estimated difference, 0.39% [95% CI, −0.23% to 0.99%], 0.95% [0.28% to 1.45%], and 1.16% [−0.09% to 2.13%]).Conclusions and RelevanceThe findings of this cohort study suggest that CGM initiation soon after diagnosis is associated with similar improvements in HbA1c for Hispanic and non-Hispanic youths as well as for publicly and privately insured youths. These results further suggest that equitable access to CGM soon after T1D diagnosis may be a first step to improve HbA1c for all youths but is unlikely to eliminate disparities entirely.Trial RegistrationClinicalTrials.gov Identifier: NCT04336969
Publisher
American Medical Association (AMA)
Cited by
5 articles.
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