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Mediating Effects of Technology-Based Therapy on the Relationship Between Socioeconomic Status and Glycemic

Joshua R Stanley1,2, Antoine B M Clarke1, Rayzel Shulman1,2

  • 1Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada.

Diabetes Technology & Therapeutics
|November 21, 2022
PubMed

Insights

Socioeconomic status impacts glycemic management in children with type 1 diabetes. Continuous glucose monitoring (CGM) and insulin pumps (CSII) use partially mediate these disparities, suggesting broader access could improve outcomes.

Area of Science:

  • Pediatrics
  • Endocrinology
  • Health Services Research

Background:

  • Socioeconomic disparities affect access to and use of diabetes technologies.
  • These technologies are crucial for effective glycemic management in type 1 diabetes (T1D).

Purpose of the Study:

  • To describe the use of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) in children with T1D.
  • To assess how CSII and CGM mediate the relationship between socioeconomic status (SES) and glycemic control.

Main Methods:

  • Retrospective cross-sectional study of 813 children (0-18 years) with T1D.
  • Data linked to material deprivation (MD) quintiles; exposures were MD and technology use (CSII, CGM); outcome was HbA1c.
  • Analysis of mediating effects of rtCGM and CSII on SES-glycemic management relationship.

Main Results:

  • 46.6% used CGM, 30.3% used CSII. Real-time CGM (rtCGM) and CSII use associated with MD and HbA1c; isCGM did not.
  • HbA1c differed by 1.17% between most and least deprived quintiles (P < 0.0001).
  • rtCGM and CSII partially mediated this difference, accounting for 12.0% and 23.1% respectively.

Conclusions:

  • CSII and rtCGM use partially mediate socioeconomic disparities in glycemic management.
  • Broader access to these technologies may improve T1D outcomes and mitigate deprivation's negative impact.

Keywords:
Continuous glucose monitoringGlycemic managementInsulin pumpPediatric type 1 diabetesSocial determinantsSocioeconomic deprivation

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