1910-LB: Disparities in Initiation of Continuous Glucose Monitoring and Impact on Glycemic Control in Children and Adolescents with Type 1 Diabetes

IF 6.2 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes Pub Date : 2024-06-21 DOI:10.2337/db24-1910-lb
METTE BORBJERG, ANNIKA V. KVIST, KALA MEHTA, NIELS EJSKJAER, JENISE C. WONG
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Abstract

Introduction & Objective: The American Diabetes Association recommends continuous glucose monitoring (CGM) for all people with type 1 diabetes (T1D) as early as the time of diagnosis. CGM has been associated with reductions in HbA1c, and it has been recommended that CGM should be initiated within 12 months of diagnosis. We aimed to determine the impact of insurance and race/ethnicity on the timing of CGM initiation in children with T1D and to compare glycemic control in those initiating CGM within six months of diagnosis compared to later initiation. Methods: Children up to age 21 years followed at UCSF Benioff Children’s Hospital diagnosed with T1D between February 2015 and September 2021 were included (n = 270) and grouped according to time of CGM initiation. Analysis of insurance and race/ethnicity was done using one-way ANOVA or Kruskal Wallis H-test. T-test and Wilcoxon test were performed to compare early and late CGM initiation. Results: The median time from T1D diagnosis to CGM initiation was 6 months for publicly insured individuals compared to 2 months for privately insured individuals (p-value < 0.001), similar differences were found between individuals of racial or ethnic minority (minority) groups and individuals identified as white, non-Hispanic. Median HbA1c was 7.5% for children with time-of-initiation < 6 months; 8.4% for children with time-of-initiation > 6 months (p-value < 0.001). Conclusion: Publicly insured children and children of minority groups experience delays in starting recommended T1D treatment with CGM, with a longer time-to-initiation as compared to privately insured children and white, non-Hispanic children. This is of clinical importance, as more optimal glycemic control has been associated with earlier initiation of CGM. Barriers to CGM initiation may result in less optimal glycemic control for publicly insured children and children of minority groups with diabetes. Disclosure M. Borbjerg: None. K. Mehta: None. N. Ejskjaer: None. J.C. Wong: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Abbott.
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1910-LB: 1 型糖尿病儿童和青少年患者开始连续血糖监测的差异及其对血糖控制的影响
导言& 目的:美国糖尿病协会建议所有 1 型糖尿病(T1D)患者在确诊后尽早进行连续血糖监测(CGM)。CGM 可降低 HbA1c,建议在确诊后 12 个月内开始使用 CGM。我们旨在确定保险和种族/人种对 T1D 儿童开始使用 CGM 的时间的影响,并比较诊断后 6 个月内开始使用 CGM 的儿童与较晚开始使用 CGM 的儿童的血糖控制情况。方法:纳入2015年2月至2021年9月期间在加州大学旧金山分校贝尼奥夫儿童医院诊断为T1D的21岁以下儿童(n = 270),并根据CGM启动时间进行分组。保险和种族/族裔分析采用单因子方差分析或 Kruskal Wallis H 检验。采用 T 检验和 Wilcoxon 检验来比较 CGM 启动时间的早晚。结果:从 T1D 诊断到开始使用 CGM 的中位时间,公费参保者为 6 个月,而自费参保者为 2 个月(P 值为 0.001),少数种族或族裔群体与白人、非西班牙裔群体之间存在类似差异。启动时间为 6 个月的儿童的 HbA1c 中位数为 7.5%;启动时间为 6 个月的儿童的 HbA1c 中位数为 8.4%(p 值为 0.001)。结论与私人保险儿童和非西班牙裔白人儿童相比,公共保险儿童和少数族裔儿童在使用 CGM 开始建议的 T1D 治疗时会出现延迟,启动时间更长。这一点具有重要的临床意义,因为血糖控制更理想与更早开始使用 CGM 有关。启动 CGM 的障碍可能会导致公共保险儿童和少数族裔糖尿病儿童的血糖控制不理想。披露 M. Borbjerg:无。K. Mehta:无。N. Ejskjaer: 无。J.C. Wong:无:研究支持;Dexcom 公司、Tandem 糖尿病护理公司、雅培公司。
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来源期刊
Diabetes
Diabetes 医学-内分泌学与代谢
CiteScore
12.50
自引率
2.60%
发文量
1968
审稿时长
1 months
期刊介绍: Diabetes is a scientific journal that publishes original research exploring the physiological and pathophysiological aspects of diabetes mellitus. We encourage submissions of manuscripts pertaining to laboratory, animal, or human research, covering a wide range of topics. Our primary focus is on investigative reports investigating various aspects such as the development and progression of diabetes, along with its associated complications. We also welcome studies delving into normal and pathological pancreatic islet function and intermediary metabolism, as well as exploring the mechanisms of drug and hormone action from a pharmacological perspective. Additionally, we encourage submissions that delve into the biochemical and molecular aspects of both normal and abnormal biological processes. However, it is important to note that we do not publish studies relating to diabetes education or the application of accepted therapeutic and diagnostic approaches to patients with diabetes mellitus. Our aim is to provide a platform for research that contributes to advancing our understanding of the underlying mechanisms and processes of diabetes.
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