Mitigating Glycemic Disparities: Understanding Contributions of Sociodemographic Variables in the Teamwork, Targets,...

Area of Science:

• Pediatric Endocrinology
• Diabetes Technology
• Health Equity

Background:

• Type 1 diabetes (T1D) management in youth requires addressing sociodemographic factors to reduce health disparities.
• Continuous Glucose Monitoring (CGM) offers potential for improved glycemic control but access and support vary.
• The Teamwork, Targets, Technology, and Tight Glycemia (4T) program was designed to integrate CGM with support for new-onset T1D.

Purpose of the Study:

• To evaluate if early CGM initiation with programmatic support in youth with T1D reduces glycemic disparities.
• To assess the impact of the 4T program on Hemoglobin A1c (HbA1c) levels across different sociodemographic groups.
• To identify key factors contributing to glycemic variability in pediatric T1D.

Main Methods:

• A prospective study involving new-onset T1D youth initiated on CGM within one month of diagnosis.
• Evaluation of HbA1c levels at 12 months, stratified by race/ethnicity, insurance, deprivation, and language.
• Comparison of outcomes across three cohorts: historical, pilot, and study 1, spanning from 2014 to 2022.

Main Results:

• In study 1, HbA1c levels were lowest among non-Hispanic White youth, those with low deprivation, private insurance, and English preference.
• Disparities in HbA1c by ethnicity and insurance were attenuated in study 1 compared to historical cohorts.
• Socioeconomic deprivation and race/ethnicity were the largest contributors to HbA1c variability (41.3% and 32.2%, respectively).

Conclusions:

• The 4T program, incorporating early CGM and support, improved glycemic outcomes and reduced disparities, particularly by insurance and ethnicity.
• Socioeconomic deprivation emerged as a significant factor influencing HbA1c variability and a target for future interventions.
• The 4T program demonstrates potential as an effective, equity-oriented model for managing pediatric T1D.