Marie Auzanneau1,2, Joachim Rosenbauer2,3, Werner Maier2,4, Simone von Sengbusch5, Johannes Hamann6, Thomas Kapellen7, Guido Freckmann8, Silke Schmidt9, Eggert Lilienthal10, Reinhard W Holl1,2. 1. Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Baden-Württemberg, Germany. 2. German Center for Diabetes Research (DZD), Neuherberg, Germany. 3. Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, North Rhine-Westphalia, Germany. 4. Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Bayern, Germany. 5. Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetes, University of Lübeck, Lübeck, Schleswig-Holstein, Germany. 6. Department of Pediatrics, St. Marien Hospital Landshut, Landshut, Germany. 7. Department of Women and Child Health, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Sachsen, Germany. 8. Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Baden-Württemberg, Ulm, Germany. 9. Department of Paediatrics and Adolescent Medicine, Klinikum Dritter Orden, Munich, Bavaria, Germany. 10. Department of Pediatrics, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Nordrhein-Westfalen, Germany.
Abstract
BACKGROUND: Despite increasing use of technology in type 1 diabetes, persistent ethnic and socio-economic disparities have been reported. We analyzed how the use of insulin pump therapy and continuous glucose monitoring (CGM) evolved over the years in Germany depending on demographics and area deprivation. METHOD: We investigated the use of insulin pump and CGM between 2016 and 2019 in 37,798 patients with type 1 diabetes aged < 26 years from the German Prospective Follow-up Registry (DPV). Associations with federal state, area-deprivation quintile (German Index of Multiple Deprivation 2010 on district level), gender, and migration background were investigated over time using multiple logistic regression. RESULTS: Between 2016 and 2019, the regional distribution of insulin pump use did not change substantially and the association with area deprivation remained non-linear and statistically non-significant. The effect of area deprivation on CGM use decreased continuously and disappeared in 2019 (OR [95%-CI] Q1 vs Q5: 1.85 [1.63-2.10] in 2016; 0.97 [0.88-1.08] in 2019). The effect of migration background on the use of either technology decreased over the years but remained significant in 2019. Girls had constantly higher odds of using an insulin pump than boys (OR: 1.25 [1.18-1.31] in 2019), whereas no gender difference was identified for CGM use. CONCLUSIONS: Although disparities decreased in Germany, access to diabetes technology still depends on migration background in 2019, and gender differences in pump use persist. As technological advances are made, further research is needed to understand the reasons for these persistent disparities.
BACKGROUND: Despite increasing use of technology in type 1 diabetes, persistent ethnic and socio-economic disparities have been reported. We analyzed how the use of insulin pump therapy and continuous glucose monitoring (CGM) evolved over the years in Germany depending on demographics and area deprivation. METHOD: We investigated the use of insulin pump and CGM between 2016 and 2019 in 37,798 patients with type 1 diabetes aged < 26 years from the German Prospective Follow-up Registry (DPV). Associations with federal state, area-deprivation quintile (German Index of Multiple Deprivation 2010 on district level), gender, and migration background were investigated over time using multiple logistic regression. RESULTS: Between 2016 and 2019, the regional distribution of insulin pump use did not change substantially and the association with area deprivation remained non-linear and statistically non-significant. The effect of area deprivation on CGM use decreased continuously and disappeared in 2019 (OR [95%-CI] Q1 vs Q5: 1.85 [1.63-2.10] in 2016; 0.97 [0.88-1.08] in 2019). The effect of migration background on the use of either technology decreased over the years but remained significant in 2019. Girls had constantly higher odds of using an insulin pump than boys (OR: 1.25 [1.18-1.31] in 2019), whereas no gender difference was identified for CGM use. CONCLUSIONS: Although disparities decreased in Germany, access to diabetes technology still depends on migration background in 2019, and gender differences in pump use persist. As technological advances are made, further research is needed to understand the reasons for these persistent disparities.
Entities:
Keywords:
CGM; deprivation; insulin pump; migration; type 1 diabetes
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