Background: The burden of T1D includes multiple visits to an endocrinologist each year, often requiring significant travel. Youth with T1D are especially impacted as pediatric endocrinologists are primarily concentrated at academic centers in urban areas.
Objectives: To assess the impact of distance to the diabetes treatment center on diabetes outcome measures. And to determine if the prevalence of technology use for the management of diabetes differs among youth with T1D living in urban versus rural communities.
Methods: Retrospective data was collected for youth ≤ 18 years of age, with a diagnosis of T1D for ≥ 6 months, seen at the Wendy Novak Diabetes Care Center. GIS mapping was used to analyze outcome measures by distance to the treatment center. Rural-Urban Commuting Area (RUCA) Codes were assigned to identify those living in metropolitan (RUCA 1-3), micropolitan (RUCA 4-6), and rural communities (RUCA 7-10).
Results: Inclusion criteria were met by 823 youth. Of these, 710 (86.3%) were white. Current CGM use was identified for 288 (35%), and pump use by 385 (46.8%). The mean distance traveled to the center was 18 miles (S.D. 8.8-52.2). Those traveling farther distances attended fewer clinic visits (p=0.0033). Those using a CGM or an insulin pump had more visits per year (p < 0.0001 and p=0.01, respectively). Among white youth, those traveling <20 miles used CGM 1.4 times more often than those traveling ≥20 miles (p=0.0196). Those living in metropolitan areas were more likely to use a CGM than those living in micropolitan or rural areas (p=0.0383).
Conclusions: Those with a greater burden of travel to receive specialty care attended fewer visits and were less likely to use CGM technology that has important benefits in improving blood glucose management and safety for those living with T1DM. This will be important to consider when developing strategies to improve access and support for this technology.
S. Watson: None. K.S. Jawad: None. M.A. Rodriguez Luna: None. K.A. Wintergerst: None.
Jaeb Center for Health Research