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A Decade of Disparities in Diabetes Technology Use and HbA1c in Pediatric Type 1 Diabetes: A Trans-Atlantic Comparison

posted on 16.09.2020 by Ananta Addala, Marie Auzanneau, Kellee Miller, Werner Maier, Nicole Foster, Thomas Kapellen, Ashby Walker, Joachim Rosenbauer, David M Maahs, Reinhard W Holl
Objective: As diabetes technology use in youth increases worldwide, inequalities in access may exacerbate disparities in hemoglobin A1c (HbA1c). We hypothesized an increasing gap in diabetes technology use by socioeconomic status (SES) would be associated with increased HbA1c disparities.

Research Design and Methods: Participants aged <18 years with diabetes duration ≥1 year in the Type 1 Diabetes Exchange (T1DX, US, n=16,457) and Diabetes Prospective Follow-up (DPV, Germany, n=39,836) registries were categorized into lowest (Q1) to highest (Q5) SES quintiles. Multiple regression analyses compared the relationship of SES quintiles with diabetes technology use and HbA1c from 2010-2012 and 2016-2018.

Results: HbA1c was higher in participants with lower SES (in 2010-2012 & 2016-2018, respectively: 8.0% & 7.8% in Q1 and 7.6% & 7.5% in Q5 for DPV; and 9.0% & 9.3% in Q1 and 7.8% & 8.0% in Q5 for T1DX). For DPV, the association between SES and HbA1c did not change between the two time periods, whereas for T1DX, disparities in HbA1c by SES increased significantly (p<0.001). After adjusting for technology use, results for DPV did not change whereas the increase in T1DX was no longer significant.

Conclusions: Although causal conclusions cannot be drawn, diabetes technology use is lowest and HbA1c is highest in those of the lowest SES quintile in the T1DX and this difference for HbA1c broadened in the last decade. Associations of SES with technology use and HbA1c were weaker in the DPV registry.


The Type 1 Diabetes Exchange Clinic Registry is supported by the Leona M. and Harry B. Helmsley Charitable Trust. The DPV registry and this analysis are supported by the German Center for Diabetes Research (DZD, grant 82DZD14A02), the German Diabetes Association, and by the European Foundation for the Study of Diabetes. Dr. Addala is supported by the Maternal Child Health Research Institute and by K12 funding at Stanford University. Dr. Maahs has research support from the NIH, JDRF, NSF, and the Helmsley Charitable Trust and his institution has research support from Medtronic, Dexcom, Insulet, Bigfoot Biomedical, Tandem, and Roche. Dr. Maahs is supported by P30DK116074.