Background: Disparities in glycemic outcomes and technology use in children with type 1 diabetes (T1D) from under-resourced backgrounds are well-documented. The feasibility of initiating automated insulin delivery (AID) soon after diagnosis of T1D is unknown in this population. This pilot study assessed the feasibility and acceptability of providing access to the Tandem Control-IQ Hybrid Closed-Loop (HCL) system to children with public insurance soon after diagnosis of T1D.
Methods: Publicly insured child ren aged 6-17 years within 3 months of T1D diagnosis were eligible for the study. Participants were randomized 2:1 to HCL or control for 6 months. Continuous glucose monitoring data for both groups were collected at baseline, 3 months, and 6 months after enrollment. Caregivers and adolescents completed a closing survey on safety and user experience.
Results: Seventeen participants were enrolled, 12 in the intervention group and 5 in the control group. The mean age was 11.5 ±2.5 years, 47% were female, 88% were from underrepresented racial or ethnic groups, 94% of caregivers did not have a college level degree, and 41% of families reported some degree of food insecurity. All families had access to smartphones, but 42% did not have access to a home computer. Of those who completed the study, a larger proportion of the intervention group compared to the control group achieved ADA benchmark of greater than 70% time in range (62% vs 0%, respectively, at 3 months, p=0.038; 37% vs 0% at 6 months, p=0.16). All caregivers in the intervention group reported satisfaction with HCL system and wished to continue using HCL technology.
Conclusion: Early initiation of AID is feasible and acceptable in youth with recently diagnosed T1D from historically marginalized racial and ethnic groups and with social risk factors associated with lower technology adoption and less optimal glycemic outcomes. Clinicians should provide education and support for AID to these families early in diagnosis to promote equity in diabetes care.
K.Yen: None. S.Belapurkar: Other Relationship; T1D Exchange, Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Medtronic. J.G.Hickey: None. L.Yglecias: None. K.S.Bal: None. L.Carelli: None. C.M.Loucel: None. M.Lodish: None. J.C.Wong: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc.
