Inequity in access to continuous glucose monitoring and health outcomes in paediatric diabetes, a case for national continuous glucose monitoring funding: A cross-sectional population study of children with type 1 diabetes in New Zealand.

Background: Continuous glucose monitoring (CGM) improves glycaemia for people affected by type 1 diabetes (T1D), but is not funded in Aotearoa/New Zealand. This study explores the impact of non-funded CGM on equity of access and associated glycaemic outcomes.
Methods: Cross-sectional population-based study collected socio-demographic (age, gender, prioritised ethnicity, socioeconomic status) and clinical data from all regional diabetes centres in New Zealand with children <15 years with T1D as of 1st October 2021. De-identified data were obtained from existing databases or chart review. Outcomes compared socio-demographic characteristics between those using all forms of CGM and self-monitoring of blood glucose (SMBG), and association with HbA1c.
Findings: 1209 eligible children were evaluated: 70.2% European, 18.1% Māori, 7.1% Pacific, 4.6% Asian, with even distribution across socioeconomic quintiles. Median HbA1c was 64 mmol/mol (8.0%), 40.2% utilised intermittently scanned (is)CGM, and 27.2% real-time (rt)CGM. CGM utilisation was lowest with Pacific ethnicity (38% lower than Māori) and the most deprived socioeconomic quintiles (quintile 5 vs. 1 adjusted RR 0.69; 95% CI, 0.57 to 0.84). CGM use was associated with regional diabetes centre (P < 0.001). The impact of CGM use on HbA1c differed by ethnicity: Māori children had the greatest difference in HbA1c between SMBG and rtCGM (adjusted difference -15.3 mmol/mol; 95% CI, -21.5 to -9.1), with less pronounced differences seen with other ethnicities.
Interpretation: Inequities in CGM use exist based on prioritised ethnicity and socioeconomic status. Importantly, CGM was independently associated with lower HbA1c, suggesting that lack of CGM funding contributes to health disparity in children with T1D.
Funding: Australasian Paediatric Endocrine Group (APEG), Canterbury Medical Research Foundation, Starship Foundation.
Competing Interests: MB has received research grants from the 10.13039/501100001505Health Research Council of New Zealand and 10.13039/501100020473Australasian Paediatric Endocrine Group. HD has no conflicts of interest to declare. CJ, RP, BW, and EW are named investigators and MdB is a named Principal Investigator on the Australasian Paediatric Endocrine Group grant provided for this study. RP has received research grants from the 10.13039/501100001505Health Research Council of New Zealand, Lotteries, 10.13039/501100001515Cure Kids, 10.13039/100011367Royal New Zealand College of General Practitioners, 10.13039/501100001529Waikato Medical Research Foundation, and 10.13039/100010061University of Waikato. RP has received educational honoraria from Eli Lilly, Boehringer Ingelheim, Novo Nordisk, Astra Zeneca, Sanofi, Novartis, and Blue Horizons. RP is on the Eli Lilly New Zealand Medical Advisory Board. RP is an Executive Member of the New Zealand Society for the Study of Diabetes, Ministry of Health Expert Diabetes Advisory Group Member, Royal Australasian College of Physicians Adult General Medicine Committee member, and Convener of the New Zealand Diabetes Guidance Group. RP was previously president of the New Zealand Society of Endocrinology. BW has received research grants and equipment from Medtronic, 10.13039/100015769Dexcom, and iSENS. JW is a named investigator on research grants received from the 10.13039/501100001505Health Research Council of New Zealand, 10.13039/501100001530Canterbury Medical Research Foundation, 10.13039/100015769Dexcom, 10.13039/501100001563Otago Medical Research Foundation, National Science Challenge, the 10.13039/100014144Rea Charitable Trust. JW has had research contracts with the Ministry of Health, New Zealand, and the Health Quality and Safety Commission, New Zealand with payments made to his employer/institution, the University of Otago. YA is Chairperson of the Tamariki Pakari Child Health and Wellbeing Trust. MdB has received research grants from 10.13039/100015769Dexcom and Medtronic, and research equipment from Dexcom, Medtronic, and Ypsomed. MdB has received honoraria from Medtronic, Ypsomed, and Dexcom.
(© 2022 The Authors.)