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Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance
Author(s) -
Addala Ananta,
Maahs David M.,
Scheinker David,
Chertow Solana,
Leverenz Brianna,
Prahalad Priya
Publication year - 2020
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.13082
Subject(s) - medicine , type 1 diabetes , diabetes mellitus , body mass index , continuous glucose monitoring , demography , multivariate analysis , endocrinology , sociology
Objective Continuous glucose monitor (CGM) use is associated with improved glucose control. We describe the effect of continued and interrupted CGM use on hemoglobin A1c (HbA1c) in youth with public insurance. Methods We reviewed 956 visits from 264 youth with type 1 diabetes (T1D) and public insurance. Demographic data, HbA1c and two‐week CGM data were collected. Youth were classified as never user , consistent user , insurance discontinuer , and self‐discontinuer . Visits were categorized as never‐user visit , visit before CGM start , visit after CGM start , visit with continued CGM use , visit with initial loss of CGM , visit with continued loss of CGM , and visit where CGM is regained after loss . Multivariate regression adjusting for age, sex, race, diabetes duration, initial HbA1c, and body mass index were used to calculate adjusted mean and delta HbA1c. Results Adjusted mean HbA1c was lowest for the consistent user group (HbA1c 8.6%;[95%CI 7.9,9.3]). Delta HbA1c (calculated from visit before CGM start ) was lower for v isit after CGM start (−0.39%;[95%CI −0.78,−0.02]) and visit with continued CGM use (−0.29%;[95%CI −0.61,0.02]), whereas it was higher for visit with initial loss of CGM (0.40%;[95%CI −0.06,0.86]), visit with continued loss of CGM (0.46%;[95%CI 0.06,0.85]), and visit where CGM is regained after loss (0.57%;[95%CI 0.06,1.10]). Conclusions Youth with public insurance using CGM have improved HbA1c, but only when CGM use is uninterrupted. Interruptions in use, primarily due to gaps in insurance coverage of CGM, were associated with increased HbA1c. These data support both initial and ongoing coverage of CGM for youth with T1D and public insurance.