Disparities in Hemoglobin A1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring.
Disparities in Hemoglobin A1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring.
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DOI：
10.1001/jamanetworkopen.2023.8881
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发表时间：
2023-04-03
影响因子：
13.8
通讯作者：
Prahalad, Priya
中科院分区：
文献类型：
--
作者：
Addala, Ananta;Ding, Victoria;Zaharieva, Dessi P.;Bishop, Franziska K.;Adams, Alyce S.;King, Abby C.;Johari, Ramesh;Scheinker, David;Hood, Korey K.;Desai, Manisha;Maahs, David M.;Prahalad, Priya
在1型糖尿病青年患者中，诊断时开始连续血糖监测（CGM）是否与血糖控制差异减少相关？在这项对135名新发1型糖尿病青年的队列研究中，无论种族或保险状况如何，在开始CGM后观察到血红蛋白A1 c的相似改善。然而，西班牙裔参与者和有公共保险的年轻人的血红蛋白A1 c水平仍然高于他们的同行。这些结果表明，扩大CGM的可及性是改善血糖结果和减少差异的潜在策略，但需要更广泛的社会策略来解决糖尿病护理差异的结构性驱动因素。这项队列研究评估了提供动态血糖监测（CGM）的新发1型糖尿病青年中不同种族和保险状况的血红蛋白A1 c（HbA 1c）水平差异。持续葡萄糖监测（CGM）与1型糖尿病（T1 D）青少年血红蛋白A1 c（HbA 1c）的改善相关;然而，来自少数民族和少数民族群体以及有公共保险的青少年在获取CGM方面面临更大的障碍。早期启动和获得CGM可能会减少CGM摄取的差异并改善糖尿病结局。确定在新诊断为T1 D并提供CGM的青年队列中，HbA 1c降低是否因种族和保险状况而异。这项队列研究使用了来自Teamwork、Targets、Technology和Tight Control（4 T）研究的数据，这是一项旨在在T1 D诊断后1个月内启动CGM的临床研究项目。所有在2018年7月25日至2020年6月15日期间在斯坦福大学儿童医院（加州的一家单点独立儿童医院）诊断为新发T1 D的青少年都被邀请参加Pilot-4 T研究，并随访12个月。数据分析于2022年6月3日进行并完成。所有符合条件的参与者在糖尿病诊断后1个月内接受CGM。为了评估HbA 1c在研究期间的变化，分析按种族（西班牙裔与非西班牙裔）或保险状况（公共与私人）分层，以比较Pilot-4 T队列与2014年6月1日至2016年12月28日期间诊断为T1 D的272名青年的历史队列。Pilot-4 T队列包括135名青年，诊断时的中位年龄为9.7岁（IQR，6.8-12.7岁）。有71名男孩（52.6%）和64名女孩（47.4%）。根据自我报告，参与者的种族被分类为亚洲或太平洋岛民（19 [14.1%]），白色（62 [45.9%]）或其他种族（39 [28.9%]）; 15名参与者（11.1%）的种族缺失或未报告。参与者还自我报告他们的种族为西班牙裔（29 [21.5%]）或非西班牙裔（92 [68.1%]）。共有104名参与者（77.0%）有私人保险，31名（23.0%）有公共保险。与历史队列相比，西班牙裔个体在诊断后6、9和12个月时观察到HbA 1c的相似降低（估计差异，−0.26% [95% CI，−1.05%至0.43%]，−0.60% [−1.46%至0.21%]，和-0.15%[-1.48%至0.80%]）和非西班牙裔个人在Pilot-4 T队列中（估计差异为−0.27% [95%CI，−0.62%至0.10%]、−0.50% [−0.81%至−0.11%]和−0.47% [−0.91%至0.06%]）。对于公共保险的个人，也观察到诊断后6个月、9个月和12个月时HbA 1c的类似降低（估计差异，−0.52% [95%CI，−1.22%至0.15%]、−0.38% [−1.26%至0.33%]和−0.57% [−2.08%至0.74%]）和私人保险个人在Pilot-4 T队列中（估计差异为−0.34% [95%CI，−0.67%至0.03%]、−0.57% [−0.85%至−0.26%]和−0.43% [−0.85%至0.01%]）。Pilot-4 T队列中的西班牙裔青年在诊断后6、9和12个月时的HbA 1c高于非西班牙裔青年（估计差异，0.28% [95% CI，-0.46%至0.86%]、0.63% [0.02%至1.20%]和1.39% [0.37%至1.96%]），公共保险的年轻人与私人保险的年轻人相比也是如此（估计差异为0.39% [95% CI，-0.23%至0.99%]，0.95% [0.28%至1.45%]和1.16% [-0.09%至2.13%]）。这项队列研究的结果表明，诊断后不久开始CGM与西班牙裔和非西班牙裔青年以及公共和私人保险青年的HbA 1c改善相似。这些结果进一步表明，T1 D诊断后不久公平获得CGM可能是改善所有年轻人HbA 1c的第一步，但不太可能完全消除差异。ClinicalTrials.gov标识符：NCT 04336969
Is inclusive initiation of continuous glucose monitoring (CGM) at diagnosis associated with reduced disparities in glycemic control among youths with type 1 diabetes? In this cohort study of 135 youths with new-onset type 1 diabetes, similar improvements in hemoglobin A1c following CGM initiation were observed irrespective of ethnicity or insurance status. However, hemoglobin A1c levels remained higher among Hispanic participants and youths with public insurance compared with their counterparts. These results suggest that expanding access to CGM is a potential strategy for improving glycemic outcomes and reducing disparities but requires broader societal strategies to address structural drivers of disparities in diabetes care. This cohort study assesses disparities in hemoglobin A1c (HbA1c) levels by ethnicity and insurance status among youths with new-onset type 1 diabetes offered continuous glucose monitoring (CGM). Continuous glucose monitoring (CGM) is associated with improvements in hemoglobin A1c (HbA1c) in youths with type 1 diabetes (T1D); however, youths from minoritized racial and ethnic groups and those with public insurance face greater barriers to CGM access. Early initiation of and access to CGM may reduce disparities in CGM uptake and improve diabetes outcomes. To determine whether HbA1c decreases differed by ethnicity and insurance status among a cohort of youths newly diagnosed with T1D and provided CGM. This cohort study used data from the Teamwork, Targets, Technology, and Tight Control (4T) study, a clinical research program that aims to initiate CGM within 1 month of T1D diagnosis. All youths with new-onset T1D diagnosed between July 25, 2018, and June 15, 2020, at Stanford Children’s Hospital, a single-site, freestanding children’s hospital in California, were approached to enroll in the Pilot-4T study and were followed for 12 months. Data analysis was performed and completed on June 3, 2022. All eligible participants were offered CGM within 1 month of diabetes diagnosis. To assess HbA1c change over the study period, analyses were stratified by ethnicity (Hispanic vs non-Hispanic) or insurance status (public vs private) to compare the Pilot-4T cohort with a historical cohort of 272 youths diagnosed with T1D between June 1, 2014, and December 28, 2016. The Pilot-4T cohort comprised 135 youths, with a median age of 9.7 years (IQR, 6.8-12.7 years) at diagnosis. There were 71 boys (52.6%) and 64 girls (47.4%). Based on self-report, participants’ race was categorized as Asian or Pacific Islander (19 [14.1%]), White (62 [45.9%]), or other race (39 [28.9%]); race was missing or not reported for 15 participants (11.1%). Participants also self-reported their ethnicity as Hispanic (29 [21.5%]) or non-Hispanic (92 [68.1%]). A total of 104 participants (77.0%) had private insurance and 31 (23.0%) had public insurance. Compared with the historical cohort, similar reductions in HbA1c at 6, 9, and 12 months postdiagnosis were observed for Hispanic individuals (estimated difference, −0.26% [95% CI, −1.05% to 0.43%], −0.60% [−1.46% to 0.21%], and −0.15% [−1.48% to 0.80%]) and non-Hispanic individuals (estimated difference, −0.27% [95% CI, −0.62% to 0.10%], −0.50% [−0.81% to −0.11%], and −0.47% [−0.91% to 0.06%]) in the Pilot-4T cohort. Similar reductions in HbA1c at 6, 9, and 12 months postdiagnosis were also observed for publicly insured individuals (estimated difference, −0.52% [95% CI, −1.22% to 0.15%], −0.38% [−1.26% to 0.33%], and −0.57% [−2.08% to 0.74%]) and privately insured individuals (estimated difference, −0.34% [95% CI, −0.67% to 0.03%], −0.57% [−0.85% to −0.26%], and −0.43% [−0.85% to 0.01%]) in the Pilot-4T cohort. Hispanic youths in the Pilot-4T cohort had higher HbA1c at 6, 9, and 12 months postdiagnosis than non-Hispanic youths (estimated difference, 0.28% [95% CI, −0.46% to 0.86%], 0.63% [0.02% to 1.20%], and 1.39% [0.37% to 1.96%]), as did publicly insured youths compared with privately insured youths (estimated difference, 0.39% [95% CI, −0.23% to 0.99%], 0.95% [0.28% to 1.45%], and 1.16% [−0.09% to 2.13%]). The findings of this cohort study suggest that CGM initiation soon after diagnosis is associated with similar improvements in HbA1c for Hispanic and non-Hispanic youths as well as for publicly and privately insured youths. These results further suggest that equitable access to CGM soon after T1D diagnosis may be a first step to improve HbA1c for all youths but is unlikely to eliminate disparities entirely. ClinicalTrials.gov Identifier: NCT04336969
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影响因子：
3.4
作者：
Addala A;Maahs DM;Scheinker D;Chertow S;Leverenz B;Prahalad P
通讯作者：
Prahalad P
影响因子：
5.8
作者：
Addala, Ananta;Zaharieva, Dessi P.;Maahs, David M.
通讯作者：
Maahs, David M.
影响因子：
16.2
作者：
Cefalu, William T.;Berg, Erika Gebel;Robinson, Shamera
通讯作者：
Robinson, Shamera
影响因子：
16.2
作者：
Johnson, Stephanie R.;Holmes-Walker, Deborah J.;Jones, Timothy W.
通讯作者：
Jones, Timothy W.
影响因子：
3.4
作者：
Ferstad JO;Vallon JJ;Jun D;Gu A;Vitko A;Morales DP;Leverenz J;Lee MY;Leverenz B;Vasilakis C;Osmanlliu E;Prahalad P;Maahs DM;Johari R;Scheinker D
通讯作者：
Scheinker D