# Correlation Between Technology and Improved Outcomes in Youth With Type 1 Diabetes Mellitus: Prospective Study Examining Outcomes for Patients With Depression and Those With Public Insurance

## TL;DR

Using diabetes technology helps improve health outcomes in teens with type 1 diabetes, especially those with depression or public insurance.

## Contribution

This study shows that diabetes technology reduces disparities linked to depression and insurance status in youth with type 1 diabetes.

## Key findings

- Youth with depression had higher HbA1c and more DKA events, but technology use reduced these risks.
- Using both a CGM and pump led to better outcomes than using one device or none.
- Publicly insured youth had higher HbA1c, but CGM use equalized outcomes with commercially insured peers.

## Abstract

Adherence to type 1 diabetes mellitus (T1DM) treatment regimens decreases during adolescence. While comorbid depression and health insurance disparities are individually known to potentiate this risk, technological devices for T1DM appear to be protective.

We examined whether technology use impacted the association between depression and poorer health outcomes in T1DM. Given established insurance-based disparities based on technology access, we also studied whether the protective effects of T1DM technology differed among publicly and privately insured youth.

Data were prospectively collected from pediatric patients with T1DM across 3 California medical centers. We used linear and negative binomial regression analyses to examine whether technology use was related to diabetes outcomes and whether this differed based on depression status (technology-by-depression interaction) and health insurance type (technology-by-insurance interaction).

Across 1573 patients aged 12 to 25 years (mean age 15.9, SD 2.9 years; n=1050, 66.4%, non-Hispanic White; n=745, 47.0% female), those with a depression diagnosis had higher hemoglobin A1c (HbA1c; mean 9.1%, SD 2.1% vs 10.1%, SD 2.2%) and more frequent diabetic ketoacidosis (DKA) events per year (mean 0.10, SD 0.36 vs 0.24, SD 0.66) than those without (P=.003). Patients using both a continuous glucose monitor (CGM) and pump had lower HbA1c levels and fewer DKA events per year (mean HbA1c 8.2%, SE 0.1%; mean DKA events per year 0.05, SE 0.01) than those using one device (mean HbA1c 9.0%, SE 0.1%; mean DKA events 0.08, SE 0.1%) or none (mean HbA1c 10.0%, SE 0.1%; mean DKA events 0.19, SE 0.1%; P<.001). While youth with public insurance had significantly higher HbA1c levels than those with commercial insurance (mean 9.3%, SD 2.1% vs 9.0%, SD 2.0%, P<.001), those using a CGM had no reliable decrease in HbA1c compared to their commercially insured peers (P=.35).

Technology use in pediatric T1DM appears protective for both youth with a history of depression and those who are publicly insured. These data underscore the importance of universal access to technology to mitigate disparities based on comorbid mental health issues and differential access to care.