S06: Breaking Barriers: Identifying Access Obstacles to Diabetes Technology in Low-Income, Type 1 Diabetic Patients
Emily Mary Donahue
University of Southern California United States
Identify key barriers to accessing continuous glucose monitors (CGMS) and care options for low-socioeconomic status (SES) patients with type 1 diabetes (T1D) on public insurance who experience lower diabetes management technologies utilization and worse clinical outcomes.
Within Clinicaltrials.gov, the keyword type 1 diabetes was searched alongside potential barriers (socioeconomic status, low-income, health literacy, barrier and racial/ethnic minority) to understand the landscape of care options for T1D patients given the availability and proven effectiveness CGMS.
Of the studies registered on Clinicaltrials.gov current as of June 23, 2020, there were 15,692 studies for “diabetes,” and 2,658 studies examining “type 1 diabetes.” Of the 285 total studies relating to the referenced search parameters, only seven trials examined barriers and T1D for low-SES patients. The other results were excluded from our data pool due to duplication, relevancy, and/or not directly studying an SES-related barrier. Moreover, research outside of clinical trials mostly consisted of small, localized studies. Current studies examined the differences in clinical outcomes of low-SES patients, specifically those on Medicaid. However, these studies often do not distinguish between type 1 and type 2 diabetes, which is an important distinction given that T1D often has a higher financial burden and a quicker onset of complications. There are currently 39 states that offer various insurance coverage for CGMs through their Medicaid programs, but have varying clinical restrictions and requirements such as: pediatric coverage only or minimum blood glucose requirement checks. Additionally, there is significant variability in reimbursement rates between states for these devices ($0-$800).
This study highlights the lack of clinical trials examining access barriers for low-SES, T1D patients as indicated by seven out of 285 relevant studies examining their intersection. Additionally, the variability found within states’ Medicaid program coverage (reimbursement rates for devices ranging from 0-800$) points to the inconsistencies in legislation and access surrounding CGMs. These findings highlight less effective diabetes management for low-SES T1D patients and a need for more intersectional clinical trial research. CGMs have been shown to lower HbA1cs and are effective in the management of diabetes. Low-SES is among the largest risk factors for poor glycemic control, as low-SES T1D patients are at approximately three times the risk for a diabetes-related death compared to other diabetic patients. There is a need for addressing the growing disparity of health outcomes and low-CGM uptake by low-SES, T1D patients, especially as more states move towards offering CGM coverage for Medicaid patients. The vast differences in state’s Medicaid CGM coverage and requirements, further emphasizes the importance of research in the disparate clinical outcomes and uptake rates amongst this patient population. This research highlights a lack of diversity and inclusion in the clinical trial space and need for more intersectional research to be conducted. There is also a financial incentive to addressing this gap, as T1D-related medical and lost income expenditures represent a loss of $14.4 billion annually in the United States. Access to CGMs increases health outcomes for low-SES patients and will reduce state Medicaid program costs for covering this population. Improved access and increased support associated with these devices is warranted, as is further research in this area. Identifying barriers responsible for low CGM uptake and poor clinical outcomes can be used to guide future policy regarding states’ Medicaid programs to better serve low-SES patients.