Disclosures: Streisand reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
September 07, 2021
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Private insurance determines CGM use by young children with type 1 diabetes

Disclosures: Streisand reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Young children newly diagnosed with type 1 diabetes were more likely to use continuous glucose monitoring regularly if they had private insurance, according to findings published in Diabetes Technology & Therapeutics.

“There were sociodemographic disparities among families who never used CGM vs. those who used CGM in any pattern during the first 18 months post-diagnosis, with insurance type emerging as the primary predictor of CGM use,” Randi Streisand, PhD, a clinical and pediatric psychologist and certified diabetes care and education specialist at Children’s National Hospital in Washington, D.C., and colleagues wrote. “Insurance has been cited as a barrier to CGM access, and publicly insured families pursuing CGM often face more obstacles, including providing documentation of at least four blood glucose checks per day and navigating durable medical equipment.”

Children with type 1 diabetes who had private insurance were more likely to use CGM regularly compared with those with public insurance. Data were derived from Sinisterra M, et al. Diabetes Technol Ther. 2021;doi:10.1089/dia.2021.0183.

Researchers analyzed data from 157 parent-child dyads who participated in a larger randomized controlled trial comparing usual diabetes care to a behavioral intervention for parents of young children aged 1 to 6 years newly diagnosed with type 1 diabetes. Dyads were recruited within 8 weeks of the child’s diabetes diagnosis. Parents self-reported baseline sociodemographic information. CGM use was self-reported at baseline, 5, 9, 12 and 18 months after diagnosis. Diabetic ketoacidosis at diagnosis and HbA1c at 18 months were obtained through medical records. Questionnaires were conducted to measure depressive symptoms and anxiety in parents.

Of the study cohort, 82% used CGM at least once during the study period. The rate of CGM use increased from 24.2% at baseline to 58% at 5 months and 65.8% at 18 months.

Researchers divided the study cohort into four CGM use trajectories. Those who used CGM at all timepoints were placed into an “always” use group (n = 22). The “later, stable” use group included those who started CGM at 5, 9 or 12 months and continued use through the end of the study (n = 53). Families who started CGM at any timepoint and exhibited an “on/off” pattern of use were put into an “inconsistent” use group (n = 51). Those who did not use CGM at all were placed into the “never” used group (n = 28).

There was no difference in race or ethnicity, child age, parent psychosocial scores, treatment condition, diabetes family history or DKA at diagnosis in any of the groups. Families with private insurance were more likely than families with public insurance to be in the always trajectory (OR = 19.94), later, stable trajectory (OR = 4.78) or inconsistent trajectory (OR = 3.75) than the never used CGM trajectory.

Participants in the always used CGM trajectory had a mean HbA1c of 7.1%, lower than the mean HbA1c of 8.4% in the never used CGM trajectory (P < .001). The later, stable CGM use trajectory also had a lower HbA1c of 7.6% compared with the never used CGM group (P < .01). There was no significant HbA1c difference between the inconsistent use and never use groups.

“Future studies should examine mechanisms that may explain the association between insurance type and CGM use among larger sample sizes, with special consideration to reasons families are not presented with the option to begin technology use soon after diagnosis and barriers inherent in the CGM initiation process,” the researchers wrote.