Abstract
Disclosure: E.M. Everett: None. R. Tiu: None. I. Melgoza: None. J. Graham: None. G. Villanueva: None. J. Menjivar Cruz: None. A. Rivas Deras: None. K. Udeze: None. J. Cushing: None. B. Escobar Barrios: None. J. Mendez: None. E. Shaw: None. C. Santana: None. B. Cobb: None. D. Polan: None. A. Naguib Guirguis: None. N. Ghaltakchyan: None. D. Chukwu: None. A. Manandhar: None. R. Hargrove: None. D. Cheng: None. M. Freeby: None. E. Ipp: None. T. Moin: None.
Background: Diabetes technology, including continuous glucose monitors (CGMs) and insulin pumps, are associated with improved type 1 diabetes (T1D) outcomes compared to management with insulin injections and glucometer. However, prior studies have shown that only 40-60% of patients with T1D use diabetes technology, with even lower rates of 26-30% in safety-net settings. To address these gaps, the state of California expanded coverage policies between 2022-2023 to support guideline-concordant CGM and pump use among individuals with T1D; we evaluated diabetes technology use in two endocrinology clinics (one academic and one safety-net). Methods: We used 2024-2025 electronic health record (EHR) data from two large health systems, an academic hospital (AH) and a safety-net hospital (SNH). We first identified patients with T1D and then conducted manual chart reviews to assess insulin pump and CGM utilization. We used Chi-squared test to evaluate differences between sites and logistic regression to evaluate the association of glycemic control and any technology use. Results: Our analytic sample included 1,685 patients with T1D (SNH=186, AH=1,499) and 86% had available demographic data. The SNH had higher proportion of uninsured patients (8% vs. 1%, p<0.001) but lower proportions of younger patients (age <45; 55% vs 69%, p<0.001), male patients (45% vs. 51%, p<0.001), White patients (13% vs. 39%, p<0.001), and English-proficient patients (79% vs. 98%, p<0.001) compared to the AH. The majority of patients in both settings used at least one form of diabetes technology (SNH= 70%, AH= 91%, p<0.001); more patients used CGMs (SNH= 70%, AH= 90%, p<0.001) than insulin pumps (SNH=42%, AH=58%, p<0.001). Use of any diabetes technology was associated with significantly greater odds of achieving glycemic targets: patients using diabetes technology had a 2.3-fold higher odds of achieving an A1c <7% (OR 2.3, 95% CI 1.61-3.37), and nearly a 4-fold higher odds of achieving an A1c <8% (OR 3.94, 95% CI 1.87-5.34), compared to non-users. Conclusions: Our recent review of 2024-2025 EHR data shows that technology use among patients with T1D from two large real-world healthcare systems in California is substantially higher than previously reported averages—even in a safety-net setting. We also found that use of diabetes technology is associated with greater odds of achieving glycemic control. Our findings suggest that recent policy changes have helped expand access to CGMs and/or insulin pumps and that access to these technologies can play a critical role in achieving diabetes care goals in real-world settings.
Presentation: Monday, July 14, 2025