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Disclosures: The authors report no relevant financial disclosures.
August 07, 2020
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Access to uninterrupted CGM crucial for publicly insured children with type 1 diabetes

Source/Disclosures
Disclosures: The authors report no relevant financial disclosures.
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Children with public health insurance may commonly face harmful insurance-related interruptions of continuous glucose monitoring that are not reversed when access is restored, according to a study published in Pediatric Diabetes.

Ananta Addala

“The few studies evaluating the use of CGM in low socioeconomic status youth utilized older-generation CGM, where discontinuation rates were higher in all groups,” Ananta Addala, DO, MPH, an instructor in the division of pediatric endocrine and diabetes at Stanford University, told Healio. “These studies showed that youth from low socioeconomic groups did not consistently wear CGM, nor was there an improvement in HbA1c. We show both that youth with public insurance, as a proxy for low socioeconomic status, wear their CGM as long as they have access, and with the sustained use of CGM, an improvement in HbA1c is noted. Of equal importance is that those with any interruptions to CGM use have poorer HbA1c outcomes, and the reacquisition of CGM after a loss does not ameliorate the adverse impact of the loss of CGM on HbA1c.”

Female diabetes insulin pump 2019
Source: Adobe Stock

Addala and colleagues conducted a retrospective chart review of 956 visits by 264 children with type 1 diabetes (mean age, 12.9 years; mean diabetes duration, 4.8 years; 51.5% boys) who had public insurance and attended Stanford Children’s Diabetes Clinic between 2010 and 2019.

The data included 149 children who never used CGM and 115 children who used CGM. Those who used CGM were categorized as consistent users without interruption (n = 69), users who discontinued CGM for insurance-related reasons (n = 30) and users who chose to discontinue CGM on their own (n = 16).

Children who used CGM had their baseline visit defined as when CGM was started. HbAc1 was recorded at baseline and at subsequent follow-up visits. If CGM use was discontinued, HbA1c and a reason for the discontinuation were recorded at the visit. For those who never used CGM, HbA1c was gathered from the most recent clinic visit available, as well as 2 years prior to the most recent visit, or the first clinic visit, whichever was earlier.

At each group’s most recent visit, the CGM never-user group had the highest adjusted mean HbA1c at 9.7%, and the consistent user group had the lowest at 8.6% (P < .001). The mean HbA1c was not statistically different for either discontinuer group when compared with the CGM never-user group.

When analyzing only children who used CGM, there was a mean decrease of .31% in HbA1c from the visit prior to beginning CGM to the visit after CGM started. Children with continued CGM use had a mean 0.3% decrease in HbA1c during that period. Those with interrupted CGM use had a mean increase in HbA1c of 0.39% at their visit following initial CGM loss (P = .027 vs. baseline; P = .011 vs. uninterrupted use), .48% at their next visit with continued CGM loss (P = .002 vs. baseline; P < .001 vs. uninterrupted use) and 0.51% at their visit where CGM restarted after loss (P = .011 vs. baseline; P = .004 vs. uninterrupted use).

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Researchers noted that 65% of CGM interruption was for insurance-related reasons, showing changes are needed to ensure youths with public insurance do not lose access to CGM.

“CGM should be offered for all youth, as the American Diabetes Association and International Society for Pediatric and Adolescent Diabetes guidelines recommend, and these data are supportive of the efficacy of CGM in improving outcomes in low-income youth,” Addala said. “The policy implication is that the current payer coverage and requirements are more onerous for youth with public insurance and appear to have a role in loss of CGM, which in turn is associated with poorer HbA1c.”

For more information:

Ananta Addala, DO, MPH, can be reached at 300 Pasteur Drive, Rm G313, Stanford, CA 94305; email: aaddala@stanford.edu; Twitter: @DrAAddala