Disparities in Continuous Glucose Monitor Use Between Children with Type 1 Diabetes Living in Urban and Rural Areas.

Objective:

Despite evidence that continuous glucose monitoring (CGM) use is associated with lower HbA1c among children with type 1 diabetes, uptake of this technology remains lower among those with difficulty accessing health care including those from lower SES backgrounds and racial and ethnic minorities. In this study, we sought to explore the impact of rural location in use of CGM technology to guide patient and provider decision-making.

Research Design and Methods:

In this retrospective study of EHR demographic and visits data from a single diabetes program from 1/1/2018 through 12/31/2021 we compared the odds of completing a visit with and without CGM interpretation between rural-urban communing area (RUCA) designations.

Results:

Among the 13,645 visits completed by 2,008 patients with type 1 diabetes under age 18, we found children living in small rural towns had 31% lower odds (6.3% of CGM+visits, 8.6% of CGM–visits, aOR:0.69 95%CI:0.51–0.94) and those living in isolated rural towns had 49% lower odds (2.0% of CGM+visits, 3.4% of CGM–visits, aOR:0.51, 95%CI:0.28–0.92) of completing a CGM-billed clinic visit compared to those living in urban areas (70.0% of CGM+visits, 67.2% of CGM–visits). We also found significant differences in CGM-billed visits by neighborhood deprivation as well as race/ethnicity and insurance payor.

Conclusions:

Geographic location presents a meaningful barrier to access to care for patients living with type 1 diabetes. Further work is needed to identify and address the needs of children and families living in rural areas to improve the care of these patients.