Hazel Scarlett
Continuous Glucose Monitoring (CGM), insulin pumps, and automated insulin administration are all examples of advances in diabetes technology that can help type 1 diabetes patients improve their glycemic control (T1D). However, diabetes technology utilization is lower in kids with government insurance, and this difference is rising in the United States. Effective treatments and policies to promote fair care are desperately needed. The following are the two goals of this case series: (1) Describe how the CGM Time in Range Program (CGM TIPs) helped children on public insurance overcome challenges to CGM and deliver asynchronous remote glucose monitoring, and (2) advocate for better CGM coverage by public insurance. We explain how six young people with T1D who had public insurance were able to receive and maintain CGM with the help of the program. Three juveniles were able to utilize persistent CGM wear to secure insurance coverage for automated insulin administration devices, and three youths were able to increase their participation with the care team while on CGM and the remote monitoring protocol. CGM TIPs assisted these teenagers in lowering their hemoglobin A1c and increasing their time in range (TIR). Despite the benefits, the expansion of CGM TIPs is hampered by strict CGM approval requirements and complicated post-approval patient protocols for receiving shipments These cases highlight the potential for combining diabetes technology and asynchronous remote monitoring to support the continued use and provide education to improve glycemic control for youth with T1D who are covered by public insurance, as well as the need to lower barriers to obtaining CGM coverage through public insurance. Long-term use of diabetes technology, such as continuous glucose monitoring (CGM) and insulin pumps, improves glycemic outcomes in children and adolescents with type 1 diabetes (T1D), lowering the risk of short- and long-term problems. The American Diabetes Association (ADA) increased the recommendation of CGM usage to all persons with diabetes who use rapid-acting insulin in 2021, while the International Society of Pediatric and Adolescent Diabetes (ISPAD) released new guidelines in 2018 that urge CGM use. Diabetes technology usage is lower in lower socioeconomic class (SES) kids in the United States, and the difference between the highest and lowest SES groups has expanded in the last decade. The gap might be attributed, at least in part, to public insurance limits on CGM coverage. Our research focuses on California Children's Services (CCS) public insurance coverage, which is a Medicaid supplement for children in California who have specific chronic health problems, such as diabetes. For CGM approval, adolescents with CCS must show four or more daily self-monitored blood glucose (SMBG) tests for a month, a criterion that does not exist for privately insured youth. These rules create structural impediments to kids on public insurance adopting technology, contributing to the inequality. The goal of this case series is to (1) describe the success stories of the CGM Time in Range Program (CGM TIPs), which removed barriers to diabetes technology adoption and provided asynchronous remote glucose monitoring for youth on public insurance, and (2) advocate for better CGM coverage by public insurance to improve diabetes care and as a gateway to Automated Insulin Delivery (AID). While larger-scale research on the problem is continuing, this case series underlines the urgent need to address systemic obstacles generating disparities in access to diabetes technologies.