Increasing Access to Diabetes Technology for Children With Type 1 Diabetes
By Sara Lyle
Researchers recently put a spotlight on which diabetes technology is most effective at helping youth with type 1 improve their health. Devices can also make them less likely to experience severe diabetes symptoms like diabetic ketoacidosis.
“Curing diabetes is the ‘holy grail,’” said Dr. Klemen Dovc, pediatric endocrinologist at the University Children’s Hospital in Ljubljana, and assistant professor at the University of Ljubljana, Slovenia.
Dovc and a group of researchers recently put a spotlight on which diabetes technology is most effective at helping youths with type 1 achieve clinical targets and makes them least likely to experience severe diabetes symptoms like hypoglycemia or diabetic ketoacidosis (DKA).
Thanks to access to a global data registry, their February 2023 study included a large sampling: 5,219 youths under 21 years old with type 1 diabetes from 21 different countries. Participants using a real-time continuous glucose monitor (CGM) plus an insulin pump had “significantly” higher time in range (TIR) – more than 70% TIR, less than 25% time above range and less than 4% time below range, to be exact.
The study concluded, “These results underscore the synergistic effect of advanced diabetes technologies that should be more readily available to youths with type 1 diabetes for further improvement of diabetes-related clinical outcomes.”
This statement begs the question of how to make such diabetes technology available to the widest number of young people with type 1 diabetes – especially when access to diabetes care is an ongoing challenge for many at home and abroad. Healthcare professionals and advocates point out that access to technology is not a substitute for proper diabetes self-management education for families dealing with the disease’s day-to-day realities.
As the study noted, participants using real-time CGMs paired with a pump – called hybrid closed-loop insulin delivery systems and sold in the U.S. under the brands Insulet, Medtronic and Tandem – had better health outcomes. “It nicely complements studies done on adults,” Dovc said of his own research, adding, “Manufactures see the benefit, too.”
Medtronic’sMiniMed 770G pump was the first automated insulin delivery (AID) system to be FDA-approved in 2020 for children as young as 2. “Type 1 diabetes is a family disease,” said Dr. Robert Vigersky, chief medical officer for Medtronic Diabetes. “The MiniMed 770G system provides a high level of care participation for parents and care partners who can leverage remote monitoring capabilities.”
For Marissa Town, clinical director at non-profit Children With Diabetes, such technology has brought diabetes treatment out of the “dark ages.” Diagnosed with type 1 diabetes as a young child, she remembers that her mom had difficulty helping her to achieve glucose targets due to the technology available at that time. She recalls her mom running after her to give her injections.
“It took two minutes to get a blood glucose reading, so we only checked it about four times a day,” Town said. “But as a toddler, my blood sugars were very likely all over the place due to the unpredictability of toddlers' activity, food intake and attitude.”
Going through this early experience, Town appreciates today’s diabetes technology even more. “Having insulin pumps that allow for more physiologic insulin dosing with flexibility for much smaller doses for small children and extended boluses for higher fat meals makes meeting targets more realistic,” she said.
Getting diabetes technology to more T1D children
“The healthcare system in this country is bass ackward – people who need [technology] training and education don't have access to it or aren't referred for it and oftentimes can't afford it,” said Gary Scheiner, owner and clinical director of Integrated Diabetes Services.
Scheiner continued, “Technology should be used for enhancing quality of life in a cost-effective way.” He explained that the cost of complications – hospitalizations and ER visits, lost worker productivity, missed school – is likely greater than the cost of a sensor or pump infusion set.
“We have to look at these technologies not as ‘cost items’ but for their cost savings,” he said.
Addressing these problems – by no means an easy task, given that a national $35 price cap for insulin was only signed into law last year – might help negate the need for grassroots organizations like Kyler Cares to fill in the gaps. The non-profit, which was founded in 2018 by Kyle Banks, Broadway actor and person with T1D, offers grants for CGMs and insulin pumps to young people with type 1 diabetes who cannot afford them, is receiving up to 10 applications per month.
“The stakes are high for these families because unstable blood sugars can lead to long-term serious complications such as nerve damage, blindness and kidney disease,” says Banks, who was diagnosed with type 1 in 2015 while performing in The Lion King. “Many of these families are already struggling to pay for necessities such as food, housing and diabetes management supplies. Complications only exacerbate financial stress and the economic burden of the disease.”
While Dovc’s study about technology in the care of type 1 children did not consider participants’ race or ethnicity, this does not diminish its importance. Said Town. “What is great about this study is that they looked at many children and young adults around the world and showed that, no matter where they lived, the diabetes technology was beneficial.”
Banks thinks more can be done at home. “We're working with a number of institutions to increase BIPOC [Black, Indigenous and People of Color] participation in clinical trials and research studies because it is important to have our experiences included as new therapies and management practices are created.”