Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance

Addala, Ananta; Maahs, David M.; Scheinker, David; Chertow, Solana; Leverenz, Brianna; Prahalad, Priya

doi:10.1111/pedi.13082

Cited by 83Diabetes Management and ResearchDiabetes Management and EducationDiabetes and associated disorders

Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance

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Addala, Ananta, Maahs, David M., Scheinker, David, Chertow, Solana, Leverenz, Brianna, Prahalad, Priya·2020·Pediatric Diabetes

DOI 10.1111/pedi.13082PMC PMC8103618

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Abstract

OBJECTIVE: Continuous glucose monitor (CGM) use is associated with improved glucose control. We describe the effect of continued and interrupted CGM use on hemoglobin A1c (HbA1c) in youth with public insurance. METHODS: We reviewed 956 visits from 264 youth with type 1 diabetes (T1D) and public insurance. Demographic data, HbA1c and two-week CGM data were collected. Youth were classified as never user, consistent user, insurance discontinuer, and self-discontinuer. Visits were categorized as never-user visit, visit before CGM start, visit after CGM start, visit with continued CGM use, visit with initial loss of CGM, visit with continued loss of CGM, and visit where CGM is regained after loss. Multivariate regression adjusting for age, sex, race, diabetes duration, initial HbA1c, and body mass index were used to calculate adjusted mean and delta HbA1c. RESULTS: Adjusted mean HbA1c was lowest for the consistent user group (HbA1c 8.6%;[95%CI 7.9,9.3]). Delta HbA1c (calculated from visit before CGM start) was lower for visit after CGM start (-0.39%;[95%CI -0.78,-0.02]) and visit with continued CGM use (-0.29%;[95%CI -0.61,0.02]), whereas it was higher for visit with initial loss of CGM (0.40%;[95%CI -0.06,0.86]), visit with continued loss of CGM (0.46%;[95%CI 0.06,0.85]), and visit where CGM is regained after loss (0.57%;[95%CI 0.06,1.10]). CONCLUSIONS: Youth with public insurance using CGM have improved HbA1c, but only when CGM use is uninterrupted. Interruptions in use, primarily due to gaps in insurance coverage of CGM, were associated with increased HbA1c. These data support both initial and ongoing coverage of CGM for youth with T1D and public insurance.

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Interruption of access to CGM is associated with worsening outcomes.
“Interruption of access to CGM is associated with a worsening of outcomes (7,15); therefore, it is important for individuals on CGM to have consistent access to devices.”
From 7. Diabetes Technology: Standards of Care in Diabetes—2025 (2025) · cites this paper as [7]

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Authors: Addala, A., Maahs, D. M., Scheinker, D., Chertow, S., Leverenz, B., & Prahalad, P.
Affiliations: Stanford Medicine (US)
Washington University in St. Louis (US)
Corresponding author: Addala, Ananta
ORCID: Addala, Ananta
Maahs, David M.
Scheinker, David
Leverenz, Brianna
Prahalad, Priya
Venue: Pediatric Diabetes
Publisher: Wiley
Published: 2020-08-10
Volume: 21
Issue: 7
Pages: 1301-1309
ISSN: 1399-543X (ISSN-L)
1399-5448
DOI: 10.1111/pedi.13082
PMC: PMC8103618
OpenAlex: W3042466372
Cited by: 83
References: 28
Citations by year: 2026: 7 · 2025: 17 · 2024: 16 · 2023: 13 · 2022: 13 · 2021: 15 · 2020: 2
FWCI: 8.11
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
doi.wiley.com/10.1002/tdm_license_1.1 (tdm)
Locations: Pediatric Diabetes (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Science Foundation
Eli Lilly and Company
Sanofi
Leona M. and Harry B. Helmsley Charitable Trust (P30DK116074)
Bigfoot Biomedical
Insulet Corporation
Dexcom
Novo Nordisk
National Institutes of Health
National Institute of Diabetes and Digestive and Kidney Diseases (R18DK122422, K12DK122550, P30DK116074)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords: continuous glucose monitoring, type 1 diabetes, youth, HbA1c, glycemic control, public insurance, insurance coverage, diabetes self-management
MeSH terms: Procedures and Techniques Utilization, Adolescent, Child, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insulin, Insurance, Health, Male, Medical Assistance, Retrospective Studies, United States, Blood Glucose Self-Monitoring, Insurance Coverage

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Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance

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