Mitigating Glycemic Disparities: Understanding Contributions of Sociodemographic Variables in the 4T Study

OBJECTIVE: To assess in youth with type 1 diabetes (T1D) whether initiation of early continuous glucose monitoring (CGM) with programmatic support to address sociodemographic barriers is associated with reduced disparities and improved glycemia. METHODS: CGM was initiated <1 month post-diagnosis with remote monitoring and <7% hemoglobin (Hb) A1c target in youth with new-onset T1D in the Teamwork, Targets, Technology, and Tight Glycemia (4T) program. We evaluated HbA1c stratified by race and ethnicity, insurance, deprivation, and language across 3 cohorts: historical (6/2014-12/2016), pilot (7/2018-6/2020), and study 1 (6/2020-03/2022). RESULTS: At 12 months in study 1, HbA1c was lowest among non-Hispanic White (6.5% [95%CI 6.2,6.9]), low deprivation (6.5% [95%CI 6.2,6.9]), private insurance (6.6% [95%CI 6.3,7]), and English preference (6.7%[95%CI 6.4,7]). HbA1c disparities were attenuated in study 1: ethnicity slopes changed from historical (0.09 [95%CI -0.02,0.20]) to pilot (0.14[ 95%CI -0.04,0.31) to study 1 (0.08 [95%CI -0.07,0.23]). Insurance slopes improved from historical (0.20 [95%CI 0.09,0.31]) to pilot (0.12 [95%CI -0.06,0.29]) to study 1 (0.01[95%CI -0.14,0.16]). Deprivation (41.3%) and race and ethnicity (32.2%) contributed most to HbA1c variability. CONCLUSIONS: Study 1 was associated with improved glycemic outcomes and attenuation of some disparities, particularly by insurance and ethnicity, supporting 4T as an effective equity-oriented care model. Deprivation emerged as a key model-derived contributor to variability in HbA1c and may represent an important target to reduce disparities in pediatric T1D glycemia.