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Social Determinants of Health Impact on Pediatric Type 1 Diabetes Outcomes Early after Diagnosis
Brittany Marks1, Claire Hecklinger2, Alexander Meyer2
1School of Medicine, University of Colorado, Aurora, Colorado, USA.
Insights
Social deprivation impacts type 1 diabetes (T1D) technology use in youth. Area-level disadvantage is linked to delayed continuous glucose monitor (CGM) and insulin pump initiation, and higher hemoglobin A1c (A1c) levels, highlighting persistent health disparities.
Area of Science:
- Pediatric endocrinology
- Health equity research
- Diabetes technology utilization
Background:
- Disparities in diabetes technology use and glycemic outcomes for US youth with type 1 diabetes (T1D) are linked to race/ethnicity and insurance status.
- The Social Deprivation Index (SDI) quantifies area-level socioeconomic disadvantage, correlating with poorer health outcomes in pediatric populations.
Purpose of the Study:
- To investigate the association between area-level socioeconomic disadvantage, measured by the Social Deprivation Index (SDI), and the uptake of diabetes technology (continuous glucose monitoring [CGM] and insulin pumps) in youth with T1D.
- To assess the impact of SDI on glycemic control (hemoglobin A1c [A1c]) over 12 months following diagnosis.
Main Methods:
- A retrospective cohort study included 1,541 youth (<19 years) newly diagnosed with T1D between 2018-2022.
- SDI was calculated based on patient addresses and categorized into quintiles (Q1=least deprived to Q5=most deprived).
- Time to CGM and insulin pump initiation, and A1c levels were analyzed using interval-censored Cox proportional hazards and linear mixed-effects models, stratified by SDI quintile.
Main Results:
- Within one year, 84% initiated CGM and 50% initiated pump therapy. Time to CGM initiation was significantly longer for patients in higher SDI quintiles (Q3-Q5) compared to Q1.
- CGM uptake was lower among Hispanic, non-Hispanic Black, and Medicaid-insured patients. Pump initiation was significantly lower only in the most deprived quintile (Q5).
- Among CGM users, the most deprived quintile (Q5) had higher A1c levels. Among non-pump users, higher SDI quintiles (Q4, Q5) also showed elevated A1c compared to Q1.
Conclusions:
- While CGM use is associated with lower A1c across all SDI levels, significant disparities in technology adoption and glycemic control persist.
- Addressing structural socioeconomic barriers is crucial for achieving equitable diabetes management outcomes in youth with T1D.
Introduction:
Disparities in diabetes technology use and glycemic outcomes among US youth with type 1 diabetes (T1D) are strongly associated with race/ethnicity and insurance. The Social Deprivation Index (SDI) offers a multidimensional measure of area-level socioeconomic disadvantage linked to poorer health outcomes in pediatric populations.
Methods:
We conducted a retrospective cohort study of 1,541 youth aged <19 years who were newly diagnosed with T1D between 2018 and 2022 at a single tertiary care center. SDI was calculated from address and categorized into quintiles (Q1 least deprived). Primary outcomes included time to continuous glucose monitor (CGM) and insulin pump initiation and hemoglobin A1c (A1c) over 12 months. Differences by SDI quintile were assessed using interval-censored Cox proportional hazards and linear mixed-effects models.
Results:
Within 1 year, 84% initiated CGM and 50% initiated pump therapy. Time to CGM initiation increased across SDI quintiles; patients in Q3-Q5 were significantly less likely to initiate CGM than Q1 (Q3: HR, 95% CI: 0.81, 0.66-0.99, p = 0.036; Q4: 0.81, 0.67-0.98, p = 0.027; Q5: 0.69, 0.56-0.86; p = 0.001). Hispanic, non-Hispanic black, and Medicaid-insured patients had lower CGM uptake. Pump initiation was significantly lower only in Q5. Among CGM users, Q5 had higher A1c than Q1 (difference 0.80%, p = 0.001). Among non-pump users, Q4 and Q5 had higher A1c than Q1. AID users had lower A1c than pump-only users (7.0% vs. 7.2%, p = 0.003).
Conclusion:
A1c is lower across all SDI levels with CGM use, but disparities persist. Addressing structural barriers is essential to achieving equity.
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