Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance.
Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance.
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DOI：
10.1111/pedi.13082
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发表时间：
2020-11
影响因子：
3.4
通讯作者：
Prahalad P
中科院分区：
文献类型：
--
作者：
Addala A;Maahs DM;Scheinker D;Chertow S;Leverenz B;Prahalad P
动态血糖监测仪（CGM）的使用与血糖控制改善相关。我们描述了持续和中断CGM使用对公共保险青年血红蛋白A1 c（HbA 1c）的影响。我们回顾了来自264名1型糖尿病（T1 D）和公共保险青年的956次就诊。收集人口统计学数据、HbA 1c和两周CGM数据。青少年被分为从不使用者，一贯使用者，保险中止者和自我中止者。访视分类为从未使用者访视、CGM开始前访视、CGM开始后访视、持续使用CGM的访视、初始CGM丧失的访视、持续CGM丧失的访视和丧失后重新获得CGM的访视。使用多变量回归校正年龄、性别、种族、糖尿病病程、初始HbA 1c和体重指数，计算校正后的平均HbA 1c和Δ HbA 1c。一致使用者组的校正平均HbA 1c最低（HbA 1c 8.6%;[95%CI 7.9，9.3]）。Δ HbA1c（根据CGM开始前的访视计算）CGM开始后的访视较低（−0.39%;[95%CI −0.78，−0.02]）和继续使用CGM的访视（−0.29%;[95%CI − 0.61，0.02]），而初始CGM丧失的访视更高（0.40%;[95%CI − 0.06，0.86]），CGM持续丢失的访视（0.46%;[95%CI 0.06，0.85]），以及CGM丢失后恢复的访视（0.57%;[95%CI 0.06，1.10]）。使用CGM的公共保险的年轻人改善了HbA 1c，但只有在CGM使用不间断的情况下。中断使用，主要是由于CGM的保险范围的差距，与HbA 1c增加。这些数据支持CGM对T1 D青年和公共保险的初始和持续覆盖。
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. 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. 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 visit 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]). 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.
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