<b>Objective:</b> As
diabetes technology use in youth increases worldwide, inequalities in access
may exacerbate disparities in hemoglobin A1c (HbA1c). We hypothesized an
increasing gap in diabetes technology use by socioeconomic status (SES) would
be associated with increased HbA1c disparities.
<p> </p>
<p><b>Research Design and
Methods: </b>Participants aged <18 years with diabetes duration ≥1 year in
the Type 1 Diabetes Exchange (T1DX, US, n=16,457) and Diabetes Prospective
Follow-up (DPV, Germany, n=39,836) registries were categorized into lowest (Q1)
to highest (Q5) SES quintiles. Multiple regression analyses compared the
relationship of SES quintiles with diabetes technology use and HbA1c from
2010-2012 and 2016-2018. </p>
<p> </p>
<p><b>Results: </b>HbA1c
was higher in participants with lower SES (in 2010-2012 & 2016-2018,
respectively: 8.0% & 7.8% in Q1 and 7.6% & 7.5% in Q5 for DPV; and 9.0%
& 9.3% in Q1 and 7.8% & 8.0% in Q5 for T1DX). For DPV, the association
between SES and HbA1c did not change between the two time periods, whereas for
T1DX, disparities in HbA1c by SES increased significantly (p<0.001). After
adjusting for technology use, results for DPV did not change whereas the
increase in T1DX was no longer significant.</p>
<p> </p>
<p><b>Conclusions: </b>Although
causal conclusions cannot be drawn, diabetes technology use is lowest and HbA1c
is highest in those of the lowest SES quintile in the T1DX and this difference for
HbA1c broadened in the last decade. Associations of SES with technology use and
HbA1c were weaker in the DPV registry. </p>
The relationship of blood glucose with cardiovascular disease is mediated over time by traditional risk factors in type 1 diabetes: the DCCT/EDIC study
