Addressing Disparities Using Continuous Glucose Monitors and Remote Patient Monitoring for Youth With Type 1 Diabetes

Ming Yeh Lee; Victor Ritter; Blake Shaw; Johannes O Ferstad; Ramesh Johari; David Scheinker; Franziska Bishop; Manisha Desai; David M Maahs; Priya Prahalad

doi:10.1177/19322968241305612

Addressing Disparities Using Continuous Glucose Monitors and Remote Patient Monitoring for Youth With Type 1 Diabetes

J Diabetes Sci Technol. 2024 Dec 23:19322968241305612. doi: 10.1177/19322968241305612. Online ahead of print.

Authors

Ming Yeh Lee¹, Victor Ritter², Blake Shaw², Johannes O Ferstad³, Ramesh Johari³, David Scheinker^{1

3

4

5}, Franziska Bishop¹, Manisha Desai², David M Maahs^{1

4

6}, Priya Prahalad^{1

4}

Affiliations

¹ Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University, Stanford, CA, USA.
² Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, CA, USA.
³ Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
⁴ Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA.
⁵ Clinical Excellence Research Center, Stanford University, Stanford, CA, USA.
⁶ Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA.

Abstract

Background: Youth with type 1 diabetes (T1D) and public insurance have lower diabetes technology use. This pilot study assessed the feasibility of a program to support continuous glucose monitor (CGM) use with remote patient monitoring (RPM) to improve glycemia for youth with established T1D and public insurance.

Methods: From August 2020 to June 2023, we provided CGM with RPM support via patient portal messaging for youth with established T1D on public insurance with challenges obtaining consistent CGM supplies. We prospectively collected hemoglobin A_1c (HbA_1c), standard CGM metrics, and diabetes technology use over 12 months.

Results: The cohort included 91 youths with median age at enrollment 14.7 years, duration of diabetes 4.4 years, 33% non-English speakers, and 44% Hispanic. Continuous glucose monitor data were consistently available (≥70%) in 23% of the participants. For the 64% of participants with paired HbA_1c values at enrollment and study end, the median HbA_1c decreased from 9.8% to 9.0% (P < .001). Insulin pump users increased from 31 to 48 and automated insulin delivery users increased from 11 to 38.

Conclusions: We established a program to support CGM use in youth with T1D and barriers to consistent CGM supplies, offering lessons for other clinics to address disparities with team-based, algorithm-enabled, remote T1D care. This real-world pilot and feasibility study noted challenges with low levels of protocol adherence and obtaining complete data in this cohort. Future iterations of the program should explore RPM communication methods that better align with this population's preferences to increase participant engagement.

Keywords: continuous glucose monitors; health disparity; pediatric diabetes; remote patient monitoring; type 1 diabetes.