Mitigating Glycemic Disparities: Understanding Contributions of Sociodemographic Variables in the Teamwork, Targets, Technology, and Tight Glycemia (4T) Study.

Abstract

To assess, in youth with type 1 diabetes (T1D), whether the initiation of early continuous glucose monitoring (CGM) with programmatic support to address sociodemographic barriers is associated with reduced disparities and improved glycemia. CGM was initiated <1 month postdiagnosis with remote monitoring and <7% glycosylated hemoglobin A1c (HbA1c) target in youth with new-onset T1D in the Teamwork, Targets, Technology, and Tight Glycemia program. We evaluated HbA1c stratified by race and ethnicity, insurance, deprivation, and language across 3 cohorts: historical (June 2014 to December 2016), pilot (July 2018 to June 2020), and study 1 (June 2020 to March 2022). At 12 months in study 1, HbA1c was lowest among non-Hispanic White (6.5%; 95% CI 6.2%-6.9%), low deprivation (6.5%; 95% CI 6.2%-6.9%), private insurance (6.6%; 95% CI 6.3%-7%), and English preference (6.7%; 95% CI 6.4%-7%). HbA1c disparities were attenuated in study 1: ethnicity slopes changed from historical (0.09; 95% CI -0.02 to 0.20) to pilot (0.14; 95% CI -0.04 to 0.31) to study 1 (0.08; 95% CI -0.07 to 0.23). Insurance slopes improved from historical (0.20; 95% CI 0.09-0.31) to pilot (0.12; 95% CI -0.06 to 0.29) to study 1 (0.01; 95%CI -0.14 to 0.16). Deprivation (41.3%) and race and ethnicity (32.2%) contributed most to HbA1c variability. Study 1 was associated with improved glycemic outcomes and attenuation of some disparities, particularly by insurance and ethnicity, supporting the Teamwork, Targets, Technology, and Tight Glycemia program as an effective equity-oriented care model. Deprivation emerged as a key model-derived contributor to variability in HbA1c and may represent an important target to reduce disparities in pediatric T1D glycemia.