Foto: Luděk Liška (2. LF)
‘Universal access to diabetes technology is key to reducing HbA1c disparities in children with type 1 diabetes’
‘Universal access to diabetes technology is key to reducing HbA1c disparities in children with type 1 diabetes’
Global Inequities in Diabetes Technology and Insulin Access and Glycemic Outcomes
Alzbeta Santova, Martin de Bock, Stefanie Lanzinger, Ellen B. Goldbloom, Natasa Bratina, Consuelo Barcala, Doha Alhomaidah, Arunkumar R. Pande, Pravesh Kumar Guness, Iveta Dzivite-Krisane, Catarina Limbert, Zdenek Sumnik | Jama Network Open | August 2025 | IF = 11.7 | doi
Key Points
Question
How is global disparity in access to diabetes technologies and insulin associated with glycemic outcomes in children with type 1 diabetes (T1D)?
Findings
This cross-sectional study collated data regarding the accessibility and reimbursement of diabetes technologies and insulin from 81 centers across 56 countries, inclusive of 42 349 children with T1D. Significant global disparity and an association between glycemic outcomes and the accessibility of diabetes technologies and insulin were found.
Meaning
Global efforts must be made to ensure universal accessibility to insulin and diabetes technologies and thereby improve disparity in glycemic outcomes for children with T1D.
Abstract
Importance
Advanced diabetes technologies such as continuous glucose monitoring (CGM), continuous subcutaneous insulin infusion (insulin pumps [CSII]), and glucometers alongside insulin access represent the criterion standard for managing type 1 diabetes (T1D) in children. Global disparities in their access and reimbursement may be associated with glycemic outcomes.
Objective
To describe how accessibility and reimbursement of advanced diabetes technologies and insulin are associated with glycated hemoglobin (HbA1c) levels in centers participating in the SWEET initiative, an international pediatric diabetes registry.
Design, Setting, and Participants
This global multicenter cross-sectional study collected data from 81 centers in 56 countries. Web-based questionnaires were distributed to representatives of all 121 pediatric diabetes centers participating in the SWEET initiative from March 1 to May 31, 2024, and used to map accessibility of and reimbursement for CGM, CSII, glucometers, and insulin. Reimbursement data were compared with HbA1c levels using the SWEET Study dataset. Participants included 42 349 children with T1D.
Exposures
Responses were categorized into 4 groups based on the extent of reimbursement for diabetes technologies and insulin.
Main Outcomes and Measures
Mean HbA1c levels across centers calculated from measurements current as of December 31, 2023, analyzed by categories of accessibility of and reimbursement for diabetes technologies and insulin.
Results
Data collected from 81 of 121 SWEET centers (67%) across 56 countries included HbA1c levels from 42 349 children with T1D (22 021 male [52%]; mean [SD] age, 14.3 [4.4] years; mean [SD] diabetes duration, 6.0 [4.2] years). Universal access with complete reimbursement for all technologies and insulin was reported by 32 centers from 19 countries, while 8 countries reported no reimbursement for any technologies or insulin. Centers with full reimbursement for CSII, CGM, glucometers, and insulin showed mean HbA1c levels of 7.62% (95% CI, 7.59%-7.64%) to 7.75% (95% CI, 7.73%-7.77%) compared with 9.65% (95% CI, 9.55%-9.71%) to 10.49% (95% CI, 10.40%-10.58%) in centers with no reimbursement and/or no availability (P < .001 for all items).
Conclusions and Relevance
This cross-sectional study found that HbA1c levels were associated with the accessibility of modern diabetes technologies and insulin. Efforts to ensure universal accessibility are required to reduce global inequities and glycemic outcomes for children with T1D.
