Abstract
Background: 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 and assess the mediating effects of each technology on the relationship between socioeconomic status and glycemic management.Methods: Single-center retrospective cross-sectional study of children aged 0-18 (n=813) with type 1 diabetes and valid postal codes between 2018-2020. Extracted data was linked to validated, census-based Material Deprivation (MD) quintiles. Exposures included material deprivation and technology use (CSII, CGM) while the primary outcome was glycemic management (HbA1c).Results: Of 813 patients included, 379 (42.5%) 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 (P<0.0001), and significant mediating effects for rtCGM & CSII use, but not isCGM. rtCGM use and CSII use accounted for 0.14% (p<0.0001) and 0.25% (p<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.Conclusions: CSII and rtCGM use partially mediated the significant discrepancies observed with socioeconomic status 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. [ABSTRACT FROM AUTHOR]