Disparities in Hemoglobin A1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring
Authors' conclusion
The findings of this cohort study suggest that CGM initiation soon after diagnosis is associated with similar improvements in HbA1c for Hispanic and non-Hispanic youths as well as for publicly and privately insured youths. These results further suggest that equitable access to CGM soon after T1D diagnosis may be a first step to improve HbA1c for all youths but is unlikely to eliminate disparities entirely.
Study context
- Population
- Youths with new-onset T1D diagnosed July 2018–June 2020 at Stanford Children's Hospital, California; median age 9.7 years; 21.5% Hispanic; 23.0% public insurance
- Participants
- 135 vs 272
- Exposure
- Pilot-4T cohort (continuous glucose monitoring (CGM) offered within 1 month of diagnosis) vs historical cohort, stratified by ethnicity and insurance status
- Pilot-4Tn = 135
- Historicaln = 272reference
- Outcome
- HbA1c change, stratified by ethnicity (Hispanic vs non-Hispanic) or insurance status (public vs private), vs historical cohort
- Follow-up
- 6, 9 and 12 months postdiagnosis
Methodological detailssingle-site, historical cohort comparison
- Single-site
- Historical cohort comparison
Main finding
As reported in the abstract
HbA1c, Pilot-4T vs historical cohort, by ethnicity and insurance
Pilot-4T vs HistoricalEstimated difference, % (95% CI)
Hispanic, 6 months
−0.26(−1.05% to 0.43%)
Hispanic, 9 months
−0.60(−1.46% to 0.21%)
Hispanic, 12 months
−0.15(−1.48% to 0.80%)
non-Hispanic, 6 months
−0.27(−0.62% to 0.10%)
non-Hispanic, 9 months
−0.50(−0.81% to −0.11%)
non-Hispanic, 12 months
−0.47(−0.91% to 0.06%)
Public insurance, 6 months
−0.52(−1.22% to 0.15%)
Public insurance, 9 months
−0.38(−1.26% to 0.33%)
Public insurance, 12 months
−0.57(−2.08% to 0.74%)
Private insurance, 6 months
−0.34(−0.67% to 0.03%)
Private insurance, 9 months
−0.57(−0.85% to −0.26%)
Private insurance, 12 months
−0.43(−0.85% to 0.01%)
Observational data: associations, not effects.
Further findings
| Outcome | Estimated difference (%) (95% CI) | |
|---|---|---|
| HbA1c, Hispanic vs non-Hispanic youths within the Pilot-4T cohort · 6, 9 and 12 months postdiagnosisHispanicvs Non-Hispanic6 months; higher with Hispanic | 0.28 (−0.46% to 0.86%) | |
| HbA1c, Hispanic vs non-Hispanic youths within the Pilot-4T cohort · 6, 9 and 12 months postdiagnosisHispanicvs Non-Hispanic9 months; higher with Hispanic | 0.63 (0.02%–1.20%) | |
| HbA1c, Hispanic vs non-Hispanic youths within the Pilot-4T cohort · 6, 9 and 12 months postdiagnosisHispanicvs Non-Hispanic12 months; higher with Hispanic | 1.39 (0.37%–1.96%) | |
| HbA1c, publicly vs privately insured youths within the Pilot-4T cohort · 6, 9 and 12 months postdiagnosisPublicly insuredvs Privately insured6 months; higher with publicly insured | 0.39 (−0.23% to 0.99%) | |
| HbA1c, publicly vs privately insured youths within the Pilot-4T cohort · 6, 9 and 12 months postdiagnosisPublicly insuredvs Privately insured9 months; higher with publicly insured | 0.95 (0.28%–1.45%) | |
| HbA1c, publicly vs privately insured youths within the Pilot-4T cohort · 6, 9 and 12 months postdiagnosisPublicly insuredvs Privately insured12 months; higher with publicly insured | 1.16 (−0.09% to 2.13%) | |
| −10123Difference, % (linear scale) |
Original publication
Disparities in Hemoglobin A1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring. JAMA Netw Open. Published 3 April 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →