Glycemic control and adoption of diabetes technology have improved significantly among US patients with type 1 diabetes (T1D) over the past 15 years, according to findings published in JAMA Network Open. Despite these advances, persistent racial, ethnic, and socioeconomic disparities highlight gaps in equitable access to care.

Researchers conducted a cross-sectional analysis using the Optum Labs Data Warehouse, which includes deidentified records from over 200 million patients. The analytic cohort consisted of 186,590 patients with T1D (26,853 children and 159,737 adults) with at least one HbA1c measurement between 2009 and 2023.

Glycemic control

• Among children, HbA1c <7% improved from 7–9% (2009–2017) to 19% (2021–2023). Mean HbA1c declined from 8.9% to 8.3%.
   
• Among adults, control improved from 21% (2009–2011) to 28% (2021–2023). Mean HbA1c declined from 8.2% to 8.0%.
   
• Control rates were higher among non-Hispanic White and commercially insured patients compared with Hispanic, non-Hispanic Black, and Medicaid-insured patients.
   

Technology uptake

• Continuous glucose monitoring (CGM): rose from 4% to 82% in children, 5% to 57% in adults.
   
• Insulin pump use: increased from 16% to 50% in children, 11% to 29% in adults.
   
• By 2021–2023, 47% of children and 22% of adults used both CGM and pump therapy.
   
• CGM disparities narrowed in recent years, but pump use differences by race, ethnicity, and insurance widened.

Across all age groups, non-Hispanic White patients with commercial insurance had the highest technology adoption and glycemic control rates, while non-Hispanic Black, Hispanic, and Medicaid-insured patients consistently lagged behind.

The authors noted that reliance on algorithms to classify T1D, missing HbA1c data among older and minority groups, and inclusion of only health care–engaged patients may affect generalizability.

“This cross-sectional study found that during the past 15 years there was a rapid increase in use of diabetes technology and notable improvements in glycemic control among youths and adults with T1D,” the authors wrote.