Conway Rebecca Baqiyyah, Snell-Bergeon Janet, Honda-Kohmo Kyoko, Peddi Anil Kumar, Isa Salbiah Binti, Sulong Shakira, Sibomana Laurien, Gerard Gonzalez Andrea, Song Jooyoun, Lomax Kate Elizabeth, Lo Ching-Nien, Kim Wondong, Haynes Aveni, de Bock Martin, Burckhardt Marie-Anne, Schwab Savannah, Hong Kwanho
Department of Epidemiology, University of Colorado, Aurora, CO 80045, USA.
American Academy of Epidemiology, Inc., Tyler, TX 75701, USA.
J Endocr Soc. 2024 Nov 28;9(1):bvae210. doi: 10.1210/jendso/bvae210. eCollection 2024 Nov 26.
Globally, nearly 9 million people are living with type 1 diabetes (T1D). Although the incidence of T1D is not affected by socioeconomic status, the development of complications and limited access to modern therapy is overrepresented in vulnerable populations. Diabetes technology, specifically continuous glucose monitoring and automated insulin delivery systems, are considered the gold standard for management of T1D, yet access to these technologies varies widely across countries and regions, and varies widely even within high-income countries. This review focuses on disparities in diabetes technology use among adolescents and young adults with T1D, barriers to access and use, and summarizes common themes emerging across countries and regions. We conducted a survey among medical technology manufacturers and physicians in various countries across diverse geographical regions and performed extensive literature searches. Across all countries and regions, economic barriers stand out as the largest and most common barriers, either preventing market penetrance of technology into a country or limiting its access to the individual with diabetes due to high out of pocket costs. Other common barriers include structural or accessibility barriers, such as stringent eligibility requirements by insurance providers, regardless of whether the insurance was private or government-based, and provider/individual level barriers. Based on the evidence presented, we suggest the need for a joint effort involving governments, private health insurers, technology manufacturers, and healthcare providers to address the global disparities of diabetic technology utilization and ensure equitable access for all individuals living with T1D worldwide.
全球范围内，近900万人患有1型糖尿病（T1D）。尽管T1D的发病率不受社会经济地位影响，但并发症的发生以及获得现代治疗的机会有限在弱势群体中更为常见。糖尿病技术，特别是持续葡萄糖监测和自动胰岛素输送系统，被认为是T1D管理的金标准，然而，这些技术的可及性在不同国家和地区差异很大，甚至在高收入国家内部也存在很大差异。本综述聚焦于患有T1D的青少年和年轻人在糖尿病技术使用方面的差异、获取和使用的障碍，并总结了不同国家和地区出现的共同主题。我们对不同地理区域的各个国家的医疗技术制造商和医生进行了一项调查，并进行了广泛的文献检索。在所有国家和地区，经济障碍都是最突出、最常见的障碍，要么阻碍技术进入某个国家的市场，要么由于高额自付费用而限制糖尿病患者获得该技术。其他常见障碍包括结构性或可及性障碍，如保险提供商（无论保险是基于私人还是政府）的严格资格要求，以及提供者/个人层面的障碍。基于所提供的证据，我们建议政府、私人健康保险公司、技术制造商和医疗保健提供者共同努力，以解决糖尿病技术利用方面的全球差异问题，并确保全球所有T1D患者都能公平获得相关技术。
