Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada.
Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
Diabetes Technol Ther. 2023 Mar;25(3):186-193. doi: 10.1089/dia.2022.0388. Epub 2022 Dec 5.
Socioeconomic disparities exist related to accessibility and uptake of diabetes technologies that impact glycemic management. The aims of this study were to describe diabetes technology use (continuous subcutaneous insulin infusion [CSII] and continuous glucose monitoring [CGM]) in children with type 1 diabetes (T1D) and assess the mediating effects of each technology on the relationship between socioeconomic status (SES) and glycemic management. Single-center retrospective cross-sectional study of children aged 0-18 years ( = 813) with T1D and valid postal codes between 2018 and 2020. Extracted data were linked to validated census-based material deprivation (MD) quintiles. Exposures included MD and technology use (CSII, CGM), whereas the primary outcome was glycemic management (HbA1c). Of 813 patients included, 379 (46.6%) and 246 (30.3%) individuals used CGM and CSII, respectively. Real-time CGM (rtCGM) and CSII were associated with both MD and HbA1c, but intermittently scanned CGM (isCGM) was not. There was a difference in HbA1c of +1.17% between patients from the most (Q5) and least deprived (Q1) MD quintile ( < 0.0001), and significant mediating effects for rtCGM and CSII use, but not isCGM. rtCGM use and CSII use accounted for 0.14% ( < 0.0001) and 0.25% ( < 0.0001) of the difference in HbA1c between patients from Q1 and Q5 quintiles (indirect effects), representing 12.0% and 23.1% of this difference, respectively. CSII and rtCGM use partially mediated the significant discrepancies observed with SES and glycemic management, highlighting potential benefits of broader access to these technologies to improve diabetes outcomes and help mitigate the negative impact of deprivation on diabetes management.
社会经济地位的差异与糖尿病技术的可及性和采用有关，这会影响血糖管理。本研究的目的是描述 1 型糖尿病（T1D）患儿的糖尿病技术使用情况（持续皮下胰岛素输注[CSII]和连续血糖监测[CGM]），并评估每种技术在社会经济地位（SES）与血糖管理之间的关系中的中介作用。
这是一项单中心回顾性横断面研究，纳入了 2018 年至 2020 年期间年龄在 0-18 岁（ = 813）、有有效邮政编码的 T1D 患儿。提取的数据与经验证的基于人口普查的物质匮乏（MD）五分位数相关联。暴露因素包括 MD 和技术使用（CSII、CGM），主要结局是血糖管理（HbA1c）。
在 813 例患者中，分别有 379 例（46.6%）和 246 例（30.3%）患者使用 CGM 和 CSII。实时 CGM（rtCGM）和 CSII 均与 MD 和 HbA1c 相关，但间歇性扫描 CGM（isCGM）则不然。来自 MD 最匮乏（Q5）和最不匮乏（Q1）五分位数的患者之间的 HbA1c 差异为 +1.17%（ < 0.0001），且 rtCGM 和 CSII 使用存在显著的中介作用，但 isCGM 则不然。rtCGM 使用率和 CSII 使用率分别占 Q1 组和 Q5 组患者 HbA1c 差异的 0.14%（ < 0.0001）和 0.25%（ < 0.0001）（间接效应），分别占该差异的 12.0%和 23.1%。
CSII 和 rtCGM 的使用部分解释了 SES 和血糖管理之间存在的显著差异，这突出表明更广泛地获得这些技术可能会改善糖尿病结局，并有助于减轻贫困对糖尿病管理的负面影响。
