JMIR Publications

ABSTRACT

Background:

Introduction: Adherence to Type 1 Diabetes Mellitus (T1DM) treatment regimens decreases during adolescence. Comorbid depression is known to potentiate this risk. While use of technological devices for T1DM can improve outcomes, several patient-level variables appear to impact access.

Objective:

We examined whether technology use impacted the association between depression and poorer health outcomes in T1DM. Given established insurance-based disparities based on technology access, we also studied whether the protective effects of T1DM technology differed among publicly and privately insured youth.

Methods:

Data were prospectively collected from pediatric patients with T1DM across three California medical centers. We used regression analyses to examine whether technology use was related to diabetes outcomes, and whether this differed based on depression status and health insurance type.

Results:

Across 1,573 patients aged 12-25 (Mage 15.9, 66.43% non-Hispanic White, 47.0% female), those with a depression diagnosis had a higher HbA1c and more frequent DKA events than those without (p < .01). Patients using both a continuous glucose monitors (CGM) and pump had lower HbA1c levels and fewer DKA events than those using no or one device (p < .01). While youth with public insurance had significantly higher HbA1c levels than those with commercial insurance, this disparity was eliminated in patients who used CGM (p < .05).

Conclusions:

Technology use in pediatric T1DM appears protective, including in youth with a history of depression and/or who are publicly insured. Facilitating access to T1DM technology may be one avenue to reducing outcome disparities. Clinical Trial: N/A