Impact of social vulnerability on glycemic control and diabetes technology use in youth with type 1 diabetes

BACKGROUND: Diabetes technology has been shown to improve glycemic control in people with type 1 diabetes (T1DM). Despite their benefits, these technologies are used less frequently by youth from lower socioeconomic backgrounds and racial minorities worldwide. This study aimed to examine the relationship between social vulnerability, disparities in diabetes technology use, and glycemic control in youth with T1DM. METHODS: This retrospective billing code analysis included 1,460 patients with T1DM, aged ≤ 23 years old, who were seen at a large academic diabetes center in the Midwest between January 2020 and April 2022, before the expansion of insurance coverage for diabetes technology in Missouri. We analyzed data on number of visit encounters, use of a continuous glucose monitor (CGM), use of an insulin pump, area of deprivation index (ADI) score, age, sex, race, and type of insurance. A predictive multiple linear regression model was used to assess mean hemoglobin A1c (HbA1c). A negative binomial regression was used to assess diabetic ketoacidosis (DKA) occurrences. RESULTS: There was statistically significant lower usage of diabetes technology in Black patients, those on Medicaid, and those with higher social vulnerability (p < 0.001). Increased rates of DKA were associated with older age, higher HbA1c, Black racial identity, and insulin pump use. Conversely, independent insulin pump or CGM use was significantly associated with lower HbA1c levels, especially among patients from the most disadvantaged groups (p < 0.001). CONCLUSIONS: This study highlights that independent insulin pump or CGM use can mitigate the negative impacts of social vulnerability and race on long term glycemic control in youth with type 1 diabetes, emphasizing the need for greater access to these essential technologies.