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Children and young people from lower socioeconomic, minority ethnic, and less-educated backgrounds are considerably less likely to use CGM. However, they experience similar improvements in glycemic control as their more advantaged peers.
A systematic review has highlighted striking inequalities in access to continuous glucose monitoring (CGM) among kids and young people with type 1 diabetes (T1D). The findings show that those from lower-income families, minority ethnic groups, and households with lower educational attainment are much less likely to use CGM, despite achieving similar health outcomes when they use it. The review examined data from 27 observational studies focusing on individuals under 26 years old with T1D.
Studies were incorporated only if they reported CGM usage broken down by social and demographic factors, such as income, education, ethnicity, and insurance type. The search covered Medline, Web of Science, and Embase databases. Studies based in low- or middle-income countries, with fewer than 500 participants, or reporting only on hybrid closed-loop systems, were eliminated. Researchers found that CGM use was consistently lower among children from socioeconomically disadvantaged backgrounds—especially among Black children, those from publicly insured households, and families with lower levels of parental education.
These trends were largely unaffected by adjustments for other factors, implying that social inequalities play a direct role in limiting access. Discontinuation rates were also greater in these groups. However, in children who were using CGM, there was little evidence to suggest that those from lower socioeconomic status or minority backgrounds had worse blood sugar control, as measured by glycated hemoglobin (HbA1c) levels. The only exception was lower parental education, which appeared to have some connection with higher HbA1c.
Interestingly, in countries where CGM is publicly reimbursed, the gap in usage between different socioeconomic status groups was narrower—pointing to the potential of policy change to curtail inequity. While only about one-third of the included studies were rated as high quality using the Newcastle-Ottawa Scale, the pattern across the data was clear. The authors could not conduct a meta-analysis due to high variability across studies. But, it did offer meaningful insights based on summary statistics and unadjusted odds ratios.
Thus, socioeconomic and ethnic disparities in CGM access continue to impact children with T1D. Yet, the equal benefit observed among users regardless of background suggests that improving access—particularly through broader reimbursement—could aid in reducing these long-standing health gaps.
Pediatric Diabetes
Equity of Continuous Glucose Monitoring in Children and Young People With Type 1 Diabetes: A Systematic Review
James Howard Dicks et al.
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