555-P: Leveling the Playing Field of Technology Access for Youth with T1D: NICH Helps, but Challenges Persist

Objective: Advancements in technology (insulin pumps, CGMs) for youth with type 1 diabetes (T1D) hold promise for better outcomes, but multiple barriers to access exist, especially for underserved and underrepresented populations. Novel Interventions in Children’s Healthcare (NICH), was designed to improve health for youth with T1D and social vulnerabilities. NICH is associated with improvements in glycemic control and reductions in complications (DKA), but less is known regarding technology access for participating youth. This study aims to 1) identify prevalence of technology use prior to and after NICH initiation and 2) examine the relationship between technology access and NICH outcomes.

Methods: Youth with T1D served by NICH (n=65) across three distinct geographical sites were included. EHR review included T1D complications (DKA), HbA1c values, and presence of T1D technology one year prior and two years following initiation of NICH services. Mean age was 15.0 years (SD=3.5); 52% female; 73% non-Hispanic White.

Results: Ten percent of youth had access to technology prior to NICH (pump=8%; CGM=2%), and 22% had access to technology 2 years post NICH initiation (pump=17%; CGM=14%). Youth were significantly more likely to gain access to CGMs (p<.01) and any T1D technology (p=.02) while in NICH. Youth with technology prior to NICH had fewer days admitted (p=.001) and ED visits (p<.01) pre-referral than those without technology. Youth who gained access to a CGM within the first year of NICH services were significantly more likely to show improvements in glycemic control (p=.01) compared to those without.

Conclusion: With rates of access hovering around 40% for CGMs and 50% for pumps, this study demonstrates that 1) youth referred to NICH experience substantial barriers to accessing T1D technology, 2) NICH participation is associated with increased access to T1D technology for socially vulnerable youth, and 3) despite program involvement, technology access inequities persist.