Background: Diabetes (DM) is a chronic illness that has major impacts on patients’ physical and emotional health. Advances in technology have aimed to improve diabetes control and lessen the burden of self-care by using continuous glucose monitors (CGM) and insulin pumps (CSII) as opposed to multiple dose injections (MDI). The goal of this study was to determine the effects of technology use on depression, DM distress, and DM control.

Methods: Patients with type 1 DM were approached at their endocrinology visits from 2018-2019 to fill out Problem Areas in Diabetes in Teenagers (PAID-T) assessment and Patient Health Questionnaire (PHQ9) screen. Inclusion criteria included age>13 years. Charts were abstracted for demographic (age, insurance) and clinical (A1c, duration of DM, technology use) information. Data was analyzed using x2 square, ANOVA, and Tukey’s test.

Results: Total of 310 patients (mean age 15.11 + 1.40 years) were included in the study with average DM duration of 5.37 + 3.86 years. CGM, CSII, and combined use were higher in the private insurance (PI) group vs. state insurance (SI) (p=0.000). When PAID-T scores were evaluated based on insurance and technology use, only insurance was associated (p=0.013), with SI being linked to higher PAID-T scores. PHQ9 scores were higher in patients with SI vs. PI (p=0.000), whereas technology use was not significant. PAID-T and PHQ9 were not related to DM duration. ANCOVA revealed that A1c was related to technology use (p=0.048), PHQ9 (p=0.018), and PAID-T scores (p=0.000). MDI use, higher PHQ9, and higher PAID-T scores were associated with higher A1c.

Conclusions: Insurance, a marker of socioeconomic status, is the principal determinant of technology use (CGM and CSII). Insurance, not technology use, is the best predictor of depression and DM distress, which are both strongly associated with higher A1c. Future efforts should be directed at improving both depression and DM distress via access to mental health services to ultimately improve DM control.


N. Patel: None. S.K. Sinha: None. K. Hong: None. B. Glick: None. R.P. Hoffman: Research Support; Spouse/Partner; Provention Bio, Inc.

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