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. 2020 Nov;21(7):1301-1309.
doi: 10.1111/pedi.13082. Epub 2020 Aug 10.

Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance

Ananta Addala  1 , David M Maahs  1   2 , David Scheinker  1   2   3 , Solana Chertow  4 , Brianna Leverenz  1 , Priya Prahalad  1
Affiliations

Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance

Ananta Addala et al. Pediatr Diabetes. 2020 Nov.

Abstract

Objective: Continuous glucose monitor (CGM) use is associated with improved glucose control. We describe the effect of continued and interrupted CGM use on hemoglobin A1c (HbA1c) in youth with public insurance.

Methods: We reviewed 956 visits from 264 youth with type 1 diabetes (T1D) and public insurance. Demographic data, HbA1c and two-week CGM data were collected. Youth were classified as never user, consistent user, insurance discontinuer, and self-discontinuer. Visits were categorized as never-user visit, visit before CGM start, visit after CGM start, visit with continued CGM use, visit with initial loss of CGM, visit with continued loss of CGM, and visit where CGM is regained after loss. Multivariate regression adjusting for age, sex, race, diabetes duration, initial HbA1c, and body mass index were used to calculate adjusted mean and delta HbA1c.

Results: Adjusted mean HbA1c was lowest for the consistent user group (HbA1c 8.6%;[95%CI 7.9,9.3]). Delta HbA1c (calculated from visit before CGM start) was lower for visit after CGM start (-0.39%;[95%CI -0.78,-0.02]) and visit with continued CGM use (-0.29%;[95%CI -0.61,0.02]), whereas it was higher for visit with initial loss of CGM (0.40%;[95%CI -0.06,0.86]), visit with continued loss of CGM (0.46%;[95%CI 0.06,0.85]), and visit where CGM is regained after loss (0.57%;[95%CI 0.06,1.10]).

Conclusions: Youth with public insurance using CGM have improved HbA1c, but only when CGM use is uninterrupted. Interruptions in use, primarily due to gaps in insurance coverage of CGM, were associated with increased HbA1c. These data support both initial and ongoing coverage of CGM for youth with T1D and public insurance.

Keywords: diabetes technology; health policy; insurance; minority health; pediatric type 1 diabetes.

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Figures

FIGURE 1
FIGURE 1
(a) Schematic of the Categorization of Youth Group Types. Legend: Of the 264 youth, 149 youth never used continuous glucose monitor (CGM), whereas 115 youth used CGM. Of the 115 youth who used CGM, 69 youth used CGM continuously throughout the study period without any interruptions in CGM use. 30 youth lost CGM due to issues with insurance coverage (paperwork, supply delivery, changes to coverage policy) and 16 youth stopped CGM due to personal preference (not wanting to wear a device, irritation from tape, loss of interest). (b) Schematic of visit type categorization. Legend: Visits for youth who used CGM were categorized into visit before CGM start (n = 115) and visit after CGM start (n = 114). The remaining 426 visits were compared to the visit prior to determine if CGM use continued without interruptions (visit with continued CGM use) or if there were interruptions to CGM use. Visit with initial Loss of CGM refers to the visit immediately following CGM discontinuation, visit with continued loss of CGM are visits where there is no CGM use at the prior or current visit, and visit where CGM is regained after loss denotes visits where there CGM use in the current visit but not at the prior visit. *1 youth lost CGM access between visit before CGM start and visit after CGM start due to supply issues and was therefore categorized as visit with initial loss of CGM
FIGURE 2
FIGURE 2
Hemoglobin A1c (HbA1c) at most recent visit for the four user groups
See this image and copyright information in PMC

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