Characterizing glycemic control and technology use among insulin-requiring patients at federally qualified health centers: a cross-sectional study

Federally Qualified Health Centers (FQHCs) serve as the primary care setting for millions of medically underserved individuals in the United States, including a substantial population living with insulin-requiring diabetes. Despite the established benefits of diabetes technology and the importance of glycemic control in preventing complications, comprehensive characterization of demographic composition, socioeconomic context, glycemic burden, and technology utilization among insulin-requiring patients in FQHCs remains limited. We aimed to provide a comprehensive contemporary characterization of this population across a geographically diverse FQHC network. We conducted a cross-sectional analysis of electronic health record data from 40 FQHCs across 17 states during 2024. The study included adults aged 18 to 75 years with type 1 diabetes (T1D) or type 2 diabetes treated with insulin (T2D). We examined demographic and socioeconomic characteristics, weighted mean HbA1c, the proportion of patients with HbA1c above 9.0%, and documented use of continuous glucose monitors (CGM) and insulin pumps. Glycemic control was compared across race and ethnicity, insurance type, and federal poverty level. Among 16,267 patients (13.8% with T1D, 54.3% female, 39.0% Hispanic, 28.0% non-Hispanic Black, 53.8% below the federal poverty level), the weighted mean HbA1c was 9.09% and 50.8% had an HbA1c above 9.0%. Glycemic control varied significantly by race and ethnicity ( P < 0.001), insurance type ( P < 0.001), and federal poverty level ( P = 0.005). Non-Hispanic Black patients with T1D had the highest mean HbA1c (9.83%), and uninsured patients had the highest mean overall (9.51%). Documented technology use was low, at 1.8% for CGM and 2.9% for insulin pumps overall, and remained low even among patients with T1D (4.3% CGM, 7.8% insulin pump). In this large, geographically diverse cohort of adults with insulin-requiring diabetes receiving care at FQHCs, more than half had an HbA1c above 9.0%, and diabetes technology documentation was markedly low across all demographic subgroups. These findings establish a critical contemporary baseline and highlight the urgent need for targeted interventions to improve glycemic control and expand technology access in safety-net settings.