The Impact of Public Policy on Equitable Access to Technology for Children and Youth Living with Type 1 Diabetes in British Columbia, Canada.

Abstract

Objective: Structural inequities impede technology uptake in marginalized populations living with type 1 diabetes (T1D). Our objective was to describe hemoglobin A1c (HbA_1c), time in range (TIR), and pump use to evaluate the impact of a universal funding policy for continuous glucose monitoring (CGM) across levels of deprivation in children with T1D in the Canadian province of British Columbia (BC). Methods: Patients with T1D and at least one outpatient visit after June 10, 2020 (1-year before universal CGM funding) who were enrolled in the BC Pediatric Diabetes Registry were included (n = 477). The Canadian Index of Multiple Deprivation (quintile 1 = least deprived; quintile 5 = most deprived) was determined using postal code. Mixed effects models were used to describe HbA_1c, TIR, and pump use, and an interrupted time series generalized additive model estimated the change in CGM use pre- and postintroduction of universal coverage. Results: No differences were observed among the five levels of deprivation for HbA_1c and TIR; however, for residential instability, those with the highest level of deprivation had a lower probability of pump use (-18.9%, 95% confidence interval [CI] = -26.1% to -11.7% for quintile 5 vs. 1). There was an increase in CGM uptake across all levels of deprivation 1-year after introduction of universal CGM funding. For example, the difference in sensor use from the most to least deprived situational group was -21.0% (-35.4%, -6.6%) at the time of universal coverage and shrank to -4.6% (-21.6%, 12.4%) after 12 months of coverage. However, an equity gap in CGM use persisted between the least and most deprived groups (-21.9, 95% CI = -34.5 to -9.4 for quintile 5 vs. 1 in economic dependency). Conclusions: Universal coverage of CGM improved uptake; however, equity gaps persisted. More research is needed to explore nonfinancial barriers to diabetes technology use in marginalized populations.