Continuous Glucose Monitoring Expands, Yet Access Remains Unequal

More people with Type 1 diabetes are using continuous glucose monitoring and insulin delivery devices to better manage their disease, but there are still disparities across race, ethnicity, and socioeconomic status for the use of these technologies and for glucose control, finds a new study recently published in JAMA Network Open.

Jung-Im Shin, M.D., Ph.D.

“While we should be celebrating the improvements, we must remember that most patients with Type 1 diabetes don’t have optimal glucose control, and there is a lot of room for improvement,” study senior author Jung-Im Shin, M.D., Ph.D., associate professor in the Johns Hopkins Bloomberg School of Public Health’s Department of Epidemiology, said in a news release.

About 2 million Americans, including 304,000 children and adolescents, have been diagnosed with Type 1 diabetes, according to the American Diabetes Association. Continuous glucose monitoring helps patients to better manage their diabetes. But uptake of glucose monitoring has remained low. For those with Type 1 diabetes, roughly half of patients in a commercially insured population used continuous glucose monitoring from 2016 to 2019, according to one study in Clinical Diabetes published in January 2024.

A study published last year in JAMA Network Open found that racial and ethnic minorities and those without insurance are less likely to be prescribed a continuous glucose monitoring device. Researchers found that among patients with both Type 1 and Type 2 diabetes, those who reported Hispanic ethnicity, Black race, or being uninsured had lower odds of receiving a continuous glucose monitoring prescription than White or insured adults.

In this newer study, researchers from Johns Hopkins Bloomberg School of Public Health used the Optum Labs Data Warehouse of de-identified electronic health records to identify patients with Type 1 diabetes. They analyzed records of 186,590 people (26,853 youth and 159,737 adults) with Type 1 diabetes across five three-year periods from 2009 to 2023.

The research team tracked individuals’ adoption of continuous glucose monitoring and insulin pump devices, as well as blood tests. They used a standard blood test for the percentage of hemoglobin bound by glucose (HbA1c) to measure glucose control. A result below 7% is recommended.

The researchers found that from the first period to the last period, there was an increase in the use of continuous glucose monitoring and insulin pumps from 2009 to 2023 among both adults and children. But the overall prevalence of glycemic control remained low. Approximately 19% of youths and 28% of adults with Type 1 diabetes had HbA1c levels less than 7%.

There was a large increase in the concurrent use of continuous glucose monitoring and insulin pumps, reaching 47% in youths and 22% in adults by the 2021-2023 period.

In the 2021-2023 study period, the use of these technologies was highest in youths younger than 13 years, those who were non-Hispanic White or those who were commercially insured. Adults who were younger, non-Hispanic White, and commercially insured were more likely to use continuous glucose monitoring or insulin pumps.

“Despite some progress, broad access to diabetes technology remains an ongoing challenge, especially among adults with T1D,” the authors wrote in the paper. “Additionally, social factors, including access to treatment and care, socioeconomic resources, and clinician bias, also influence glycemic control and likely disparities in T1D management. Reducing disparities will require broadening access to novel technologies, along with interventions that address social determinants of health.”