Abstract
Advancements in diabetes technology such as continuous glucose monitoring (CGM), insulin pumps, and automated insulin delivery provide opportunities to improve glycemic control for youth with type 1 diabetes (T1D). However, diabetes technology use is lower in youth on public insurance, and this technology use gap is widening in the US. There is a significant need to develop effective interventions and policies to promote equitable care. The dual purpose of this case series is as follows: (1) describe success stories of the CGM Time in Range Program (CGM TIPs), which removed barriers for initiating CGM and provided asynchronous remote glucose monitoring for youth on public insurance, and (2) advocate for improving CGM coverage by public insurance. We describe a series of six youths with T1D and public insurance who obtained and sustained use of CGM with assistance from the program. Three youths had improved engagement with the care team while on CGM and the remote monitoring protocol, and three youths were able to leverage sustained CGM wear to obtain insurance coverage for automated insulin delivery systems. CGM TIPs helped these youths achieve lower hemoglobin A1c and improved time in range (TIR). Despite the successes, expansion of CGM TIPs is limited by stringent barriers for CGM approval and difficult postapproval patient workflows to receive shipments. These cases highlight the potential for combining diabetes technology and asynchronous remote monitoring to support continued use and provide education to improve glycemic control for youth with T1D on public insurance and the need to reduce barriers for obtaining CGM coverage by public insurance.
Highlights
Sustained use of diabetes technology, such as continuous glucose monitoring (CGM) and insulin pumps, improves glycemic outcomes in youth with type 1 diabetes (T1D), thereby reducing the risk for short-term and long-term complications [1–10]. e 2021 American Diabetes Association (ADA) standards of care expanded recommendation of CGM use to all people with diabetes on rapid-acting insulin [11], and the International Society of Pediatric and Adolescent Diabetes (ISPAD) 2018 guidelines encourage CGM use [8]
In the United States, diabetes technology use is lower in youth of lower socioeconomic status (SES), and the gap of technology use between the highest and lowest SES groups has widened in the past decade [13–16]. e disparity may be, at least in part, due to restrictions in coverage for CGM by public insurance [17]
Our study focuses on public insurance coverage by California Children’s Services (CCS), a Medicaid supplement for children in California with certain chronic health conditions, including diabetes
Summary
Sustained use of diabetes technology, such as continuous glucose monitoring (CGM) and insulin pumps, improves glycemic outcomes in youth with type 1 diabetes (T1D), thereby reducing the risk for short-term and long-term complications [1–10]. e 2021 American Diabetes Association (ADA) standards of care expanded recommendation of CGM use to all people with diabetes on rapid-acting insulin [11], and the International Society of Pediatric and Adolescent Diabetes (ISPAD) 2018 guidelines encourage CGM use [8]. E purpose of this case series is as follows: (1) describe success stories of the CGM Time in Range Program (CGM TIPs), which removed barriers for initiating diabetes technology and provided Case Reports in Endocrinology asynchronous remote glucose monitoring for youth on public insurance, and (2) advocate for improving CGM coverage by public insurance to improve diabetes care and as a gateway to automated insulin delivery (AID).
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