Socioeconomic status and diabetes technology use in youth with type 1 diabetes: a comparison of two funding models.

Autor:	Lomax KE; Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia.; Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia., Taplin CE; Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia.; Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.; Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia., Abraham MB; Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia.; Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.; Division of Paediatrics within the Medical School, The University of Western Australia, Perth, WA, Australia., Smith GJ; Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia., Haynes A; Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia., Zomer E; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia., Ellis KL; Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia., Clapin H; Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia., Zoungas S; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia., Jenkins AJ; Diabetes and Vascular Medicine, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia., Harrington J; Division of Endocrinology, Women's and Children's Health Network, North Adelaide, SA, Australia.; Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia., de Bock MI; Department of Paediatrics, University of Otago, Christchurch, New Zealand., Jones TW; Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia.; Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.; Division of Paediatrics within the Medical School, The University of Western Australia, Perth, WA, Australia., Davis EA; Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia.; Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.; Division of Paediatrics within the Medical School, The University of Western Australia, Perth, WA, Australia.
Jazyk:	angličtina
Zdroj:	Frontiers in endocrinology [Front Endocrinol (Lausanne)] 2023 Aug 21; Vol. 14, pp. 1178958. Date of Electronic Publication: 2023 Aug 21 (Print Publication: 2023).
DOI:	10.3389/fendo.2023.1178958
Abstrakt:	Background: Technology 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. Methods: A 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. Results: CGM 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. Conclusion: In 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. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2023 Lomax, Taplin, Abraham, Smith, Haynes, Zomer, Ellis, Clapin, Zoungas, Jenkins, Harrington, de Bock, Jones and Davis.)
Databáze:	MEDLINE
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