Socioeconomic status and diabetes technology use in youth with type 1 diabetes: a comparison of two funding models
BackgroundTechnology use, including continuous glucose monitoring (CGM) and insulin pump therapy, is associated with improved outcomes in youth with type 1 diabetes (T1D). In 2017 CGM was universally funded for youth with T1D in Australia. In contrast, pump access is primarily accessed through priva...
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| Format: | Article |
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2023.1178958/full |
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| author | Kate E. Lomax Kate E. Lomax Craig E. Taplin Craig E. Taplin Craig E. Taplin Mary B. Abraham Mary B. Abraham Mary B. Abraham Grant J. Smith Aveni Haynes Ella Zomer Katrina L. Ellis Helen Clapin Sophia Zoungas Alicia J. Jenkins Alicia J. Jenkins Jenny Harrington Jenny Harrington Martin I. de Bock Timothy W. Jones Timothy W. Jones Timothy W. Jones Elizabeth A. Davis Elizabeth A. Davis Elizabeth A. Davis |
| author_facet | Kate E. Lomax Kate E. Lomax Craig E. Taplin Craig E. Taplin Craig E. Taplin Mary B. Abraham Mary B. Abraham Mary B. Abraham Grant J. Smith Aveni Haynes Ella Zomer Katrina L. Ellis Helen Clapin Sophia Zoungas Alicia J. Jenkins Alicia J. Jenkins Jenny Harrington Jenny Harrington Martin I. de Bock Timothy W. Jones Timothy W. Jones Timothy W. Jones Elizabeth A. Davis Elizabeth A. Davis Elizabeth A. Davis |
| author_sort | Kate E. Lomax |
| collection | DOAJ |
| description | BackgroundTechnology use, including continuous glucose monitoring (CGM) and insulin pump therapy, is associated with improved outcomes in youth with type 1 diabetes (T1D). In 2017 CGM was universally funded for youth with T1D in Australia. In contrast, pump access is primarily accessed through private health insurance, self-funding or philanthropy. The study aim was to investigate the use of diabetes technology across different socioeconomic groups in Australian youth with T1D, in the setting of two contrasting funding models.MethodsA cross-sectional evaluation of 4957 youth with T1D aged <18 years in the national registry was performed to determine technology use. The Index of Relative Socio-Economic Disadvantage (IRSD) derived from Australian census data is an area-based measure of socioeconomic status (SES). Lower quintiles represent greater disadvantage. IRSD based on most recent postcode of residence was used as a marker of SES. A multivariable generalised linear model adjusting for age, diabetes duration, sex, remoteness classification, and location within Australia was used to determine the association between SES and device use.ResultsCGM use was lower in IRSD quintile 1 in comparison to quintiles 2 to 5 (p<0.001) where uptake across the quintiles was similar. A higher percentage of pump use was observed in the least disadvantaged IRSD quintiles. Compared to the most disadvantaged quintile 1, pump use progressively increased by 16% (95% CI: 4% to 31%) in quintile 2, 19% (6% to 33%) in quintile 3, 35% (21% to 50%) in quintile 4 and 51% (36% to 67%) in the least disadvantaged quintile 5.ConclusionIn this large national dataset, use of diabetes technologies was found to differ across socioeconomic groups. For nationally subsidised CGM, use was similar across socioeconomic groups with the exception of the most disadvantaged quintile, an important finding requiring further investigation into barriers to CGM use within a nationally subsidised model. User pays funding models for pump therapy result in lower use with socioeconomic disadvantage, highlighting inequities in this funding approach. For the full benefits of diabetes technology to be realised, equitable access to pump therapy needs to be a health policy priority. |
| first_indexed | 2024-03-12T14:04:00Z |
| format | Article |
| id | doaj.art-ae185cb4458b48389965c815cc5dfba2 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-03-12T14:04:00Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Endocrinology |
| spelling | doaj.art-ae185cb4458b48389965c815cc5dfba22023-08-21T17:04:20ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922023-08-011410.3389/fendo.2023.11789581178958Socioeconomic status and diabetes technology use in youth with type 1 diabetes: a comparison of two funding modelsKate E. Lomax0Kate E. Lomax1Craig E. Taplin2Craig E. Taplin3Craig E. Taplin4Mary B. Abraham5Mary B. Abraham6Mary B. Abraham7Grant J. Smith8Aveni Haynes9Ella Zomer10Katrina L. Ellis11Helen Clapin12Sophia Zoungas13Alicia J. Jenkins14Alicia J. Jenkins15Jenny Harrington16Jenny Harrington17Martin I. de Bock18Timothy W. Jones19Timothy W. Jones20Timothy W. Jones21Elizabeth A. Davis22Elizabeth A. Davis23Elizabeth A. Davis24Department of Endocrinology and Diabetes, Perth Children’s Hospital, Nedlands, WA, AustraliaChildren’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, AustraliaDepartment of Endocrinology and Diabetes, Perth Children’s Hospital, Nedlands, WA, AustraliaChildren’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, AustraliaCentre for Child Health Research, The University of Western Australia, Perth, WA, AustraliaDepartment of Endocrinology and Diabetes, Perth Children’s Hospital, Nedlands, WA, AustraliaChildren’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, AustraliaDivision of Paediatrics within the Medical School, The University of Western Australia, Perth, WA, AustraliaChildren’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, AustraliaChildren’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, AustraliaSchool of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, AustraliaDepartment of Endocrinology and Diabetes, Perth Children’s Hospital, Nedlands, WA, AustraliaChildren’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, AustraliaSchool of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, AustraliaDiabetes and Vascular Medicine, Baker Heart and Diabetes Institute, Melbourne, VIC, AustraliaNHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, AustraliaDivision of Endocrinology, Women’s and Children’s Health Network, North Adelaide, SA, AustraliaFaculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia0Department of Paediatrics, University of Otago, Christchurch, New ZealandDepartment of Endocrinology and Diabetes, Perth Children’s Hospital, Nedlands, WA, AustraliaChildren’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, AustraliaDivision of Paediatrics within the Medical School, The University of Western Australia, Perth, WA, AustraliaDepartment of Endocrinology and Diabetes, Perth Children’s Hospital, Nedlands, WA, AustraliaChildren’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, AustraliaDivision of Paediatrics within the Medical School, The University of Western Australia, Perth, WA, AustraliaBackgroundTechnology use, including continuous glucose monitoring (CGM) and insulin pump therapy, is associated with improved outcomes in youth with type 1 diabetes (T1D). In 2017 CGM was universally funded for youth with T1D in Australia. In contrast, pump access is primarily accessed through private health insurance, self-funding or philanthropy. The study aim was to investigate the use of diabetes technology across different socioeconomic groups in Australian youth with T1D, in the setting of two contrasting funding models.MethodsA cross-sectional evaluation of 4957 youth with T1D aged <18 years in the national registry was performed to determine technology use. The Index of Relative Socio-Economic Disadvantage (IRSD) derived from Australian census data is an area-based measure of socioeconomic status (SES). Lower quintiles represent greater disadvantage. IRSD based on most recent postcode of residence was used as a marker of SES. A multivariable generalised linear model adjusting for age, diabetes duration, sex, remoteness classification, and location within Australia was used to determine the association between SES and device use.ResultsCGM use was lower in IRSD quintile 1 in comparison to quintiles 2 to 5 (p<0.001) where uptake across the quintiles was similar. A higher percentage of pump use was observed in the least disadvantaged IRSD quintiles. Compared to the most disadvantaged quintile 1, pump use progressively increased by 16% (95% CI: 4% to 31%) in quintile 2, 19% (6% to 33%) in quintile 3, 35% (21% to 50%) in quintile 4 and 51% (36% to 67%) in the least disadvantaged quintile 5.ConclusionIn this large national dataset, use of diabetes technologies was found to differ across socioeconomic groups. For nationally subsidised CGM, use was similar across socioeconomic groups with the exception of the most disadvantaged quintile, an important finding requiring further investigation into barriers to CGM use within a nationally subsidised model. User pays funding models for pump therapy result in lower use with socioeconomic disadvantage, highlighting inequities in this funding approach. For the full benefits of diabetes technology to be realised, equitable access to pump therapy needs to be a health policy priority.https://www.frontiersin.org/articles/10.3389/fendo.2023.1178958/fulltype 1 diabetes (T1D)paediatricssocioeconomicsequitymodel of caretechnology |
| spellingShingle | Kate E. Lomax Kate E. Lomax Craig E. Taplin Craig E. Taplin Craig E. Taplin Mary B. Abraham Mary B. Abraham Mary B. Abraham Grant J. Smith Aveni Haynes Ella Zomer Katrina L. Ellis Helen Clapin Sophia Zoungas Alicia J. Jenkins Alicia J. Jenkins Jenny Harrington Jenny Harrington Martin I. de Bock Timothy W. Jones Timothy W. Jones Timothy W. Jones Elizabeth A. Davis Elizabeth A. Davis Elizabeth A. Davis Socioeconomic status and diabetes technology use in youth with type 1 diabetes: a comparison of two funding models Frontiers in Endocrinology type 1 diabetes (T1D) paediatrics socioeconomics equity model of care technology |
| title | Socioeconomic status and diabetes technology use in youth with type 1 diabetes: a comparison of two funding models |
| title_full | Socioeconomic status and diabetes technology use in youth with type 1 diabetes: a comparison of two funding models |
| title_fullStr | Socioeconomic status and diabetes technology use in youth with type 1 diabetes: a comparison of two funding models |
| title_full_unstemmed | Socioeconomic status and diabetes technology use in youth with type 1 diabetes: a comparison of two funding models |
| title_short | Socioeconomic status and diabetes technology use in youth with type 1 diabetes: a comparison of two funding models |
| title_sort | socioeconomic status and diabetes technology use in youth with type 1 diabetes a comparison of two funding models |
| topic | type 1 diabetes (T1D) paediatrics socioeconomics equity model of care technology |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2023.1178958/full |
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