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REDUCING DISPARITIES IN HEMOGLOBIN A1C DURING THE FIRST YEAR OF DIABETES DIAGNOSIS: ACCOMPLISHMENTS AND AREAS FOR IMPROVEMENT IN THE 4T STUDY
Background and Aims
Continuous glucose monitoring (CGM) is associated with significant improvements in hemoglobin A1c (HbA1c) in youth with type 1 diabetes (T1D). Youth from racial/ethnic minority groups and youth with public insurance use CGM less and have higher HbA1c. To expand CGM access, all youth with T1D were offered CGM within one month of diagnosis through the 4T Study.
We recruited 135 youth with new-onset diabetes to the 4T study (diagnosed 2018-2020) and compared HbA1c levels with a historical cohort (diagnosed 2014-2016) over a 12-month period by race/ethnicity and insurance status. Utilizing locally estimated scatter plot smoothing, descriptive differences in HbA1c by groups were evaluated.
Hispanic youth and youth with public insurance in the 4T cohort had an improvement in HbA1c when compared to historical counterparts (Figures 1a & 1b). Within the 4T cohort, compared to youth with private insurance, youth with public insurance had a lower HbA1c at diagnosis but higher HbA1c by 12 months (Figure 1a). Similarly, compared to non-Hispanic white youth, Hispanic youth had lower HbA1c at diagnosis but higher HbA1c by 12 months post-diagnosis (Figure 1b).
While Hispanic youth and youth with public insurance experienced improvements in HbA1c with the 4T intervention, disparities in HbA1c outcomes by race/ethnicity and public insurance persisted within the 4T cohort. Thus, expanding CGM access in this cohort improved, but did not eliminate HbA1c disparities by race/ethnicity and insurance status. These data support expanding CGM access to all youth with T1D and underscore the need to address additional drivers of diabetes disparities.