Introduction: The impact of the Covid-pandemic on diabetes device uptake and use in youth with T1D is unclear. We assessed demographic, diabetes, and SES characteristics associated with diabetes technology (pump, CGM) use in youth with T1D, aged ≤18 years, pre- and during the pandemic.
Methods: EHR provided ∼18 months of data pre- and during the pandemic. Pump and CGM use were defined as device use at ≥50% of visits. Geocoding provided census tract-specific SES measures from the 20American Community Survey. Logistic regression models analyzed the probability of device use vs. non-use in the pre- and pandemic periods by geocoded SES status, adjusted for age, gender, baseline A1c, and T1D duration.
Results: Pre-pandemic sample had 734 youth (male 49%, aged 13.8±3.3 years, T1D duration 7.3±3.4 years) ; pandemic sample had 800 youth (male 51%, aged 13.4±3.7 years, T1D duration 6.6±3.9 years) ; 689 were in both periods. Pre- and during pandemic, respectively, there were 25% and 22% device non-users; 19% and 21% pump only; 13% and 16% CGM only; 43% and 41% both. Pre-pandemic baseline A1c differed by the 4 device use groups: non-users 9.1±1.7%; pump 8.5±1.2%; CGM 8.2±1.2%; both 8.1±1.0%; p<.05.In both periods, the odds of device non-users starting a device were reduced in those from low-income tracts (≤$40,000) (pre: OR 0.60, 95%CI 0.40-0.91; during: OR 0.59, 95%CI 0.39-0.88; respectively, both p=.01) and low education tracts (≥30% high school or less) (pre: OR 0.57, 95%CI 0.39-0.85; during: OR 0.65, 95%CI 0.44-0.97; both p≤.03) . While the odds of CGM uptake were significantly reduced by ∼40% in presence of unfavorable census SES factors (p≤.01) , the odds of pump start were not (p≥.05) . Odds of uptake of both devices were significantly reduced by ∼45% in presence of unfavorable census SES factors (p≤.02) in both periods.
Conclusion: During the pandemic, there remained decreased uptake and less continued use of diabetes device in lower SES patients. Further work is needed to decrease the inequality gap.
C.Chen: None. A.Adam: None. S.Ojukwu: None. T.Kaushal: None. L.J.Tinsley: None. L.K.Volkening: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc.
National Institutes of Health (P30DK036836,T32DK007260)