Trends and Disparities in Technology Use and Glycemic Control in Type 1 Diabetes

Importance Characterizing population-level changes in type 1 diabetes (T1D) management can inform public health policies and interventions. Objective To characterize trends and disparities in glycemic control and use of diabetes technology among US youths and adults with T1D. Design, Setting, and Participants This serial, cross-sectional analysis used the Optum Labs Data Warehouse, a national, deidentified database of electronic health records, to identify US youths (aged lt;18 years) and adults (aged ≥18 years) with T1D. Data were obtained from records from January 1, 2009, to December 31, 2023. Exposures Calendar years divided into 3-year study periods from 2009 to 2011 to 2021 to 2023. Main Outcomes and Measures Glycemic control (mean hemoglobin A 1c level, lt;7%) and use of diabetes technology (continuous glucose monitoring systems and/or insulin pumps) were defined using laboratory data and prescriptions, procedures, and diagnoses codes from electronic health records. Results A total of 186 590 participants with T1D was identified (mean SD age, 40 19 years; 96 766 52% male; 12 493 7% Hispanic, 2819 2% non-Hispanic Asian, 21 459 12% non-Hispanic Black, and 141 847 76% non-Hispanic White). Of these, 26 853 participants were youths (mean SD age, 12 4 years; 14 060 52% male; 19 822 74% non-Hispanic White) and 159 737 were adults (mean SD age, 45 16 years; 82 706 52% male; 122 025 76% non-Hispanic White). From the 2009-2011 to 2021-2023 study periods, the prevalence of glycemic control (mean hemoglobin A 1c level lt;7%) increased from 7% (95% CI, 7%-8%) to 19% (95% CI, 19%-20%) in youths ( P lt; .001 for trend) and 21% (95% CI, 21%-22%) to 28% (95% CI, 28%-29%) in adults ( P lt; .001 for trend). During this same period, there was a substantial increase in the percentage of patients using continuous glucose monitoring (4% to 82% for youths; 5% to 57% for adults), insulin pumps (16% to 50% for youths; 11% to 29% for adults), and both devices concurrently (1% to 47% for youths; 1% to 22% for adults) ( P lt; .001 for trend for all). The prevalence of glycemic control and use of diabetes technology were lowest in Hispanic, non-Hispanic Black, and Medicaid-insured youths and adults, and differences persisted or increased over time. Conclusions and Relevance In this cross-sectional study, there was a rapid increase in the use of diabetes technology and notable improvements in glycemic control among youths and adults with T1D during the past 15 years. Nonetheless, the prevalence of glycemic control remained low, and racial, ethnic, and socioeconomic differences grew over time.