Mediating Effects of Technology-Based Therapy on the Relationship Between Socioeconomic Status and Glycemic Management in Pediatric Type 1 Diabetes

Diabetes Technol Ther. 2023 Mar;25(3):186-193. doi: 10.1089/dia.2022.0388. Epub 2022 Dec 5.


Background: Socioeconomic disparities exist related to accessibility and uptake of diabetes technologies that impact glycemic management. The aims of this study were to describe diabetes technology use (continuous subcutaneous insulin infusion [CSII] and continuous glucose monitoring [CGM]) in children with type 1 diabetes (T1D) and assess the mediating effects of each technology on the relationship between socioeconomic status (SES) and glycemic management. Methods: Single-center retrospective cross-sectional study of children aged 0-18 years (n = 813) with T1D and valid postal codes between 2018 and 2020. Extracted data were linked to validated census-based material deprivation (MD) quintiles. Exposures included MD and technology use (CSII, CGM), whereas the primary outcome was glycemic management (HbA1c). Results: Of 813 patients included, 379 (46.6%) and 246 (30.3%) individuals used CGM and CSII, respectively. Real-time CGM (rtCGM) and CSII were associated with both MD and HbA1c, but intermittently scanned CGM (isCGM) was not. There was a difference in HbA1c of +1.17% between patients from the most (Q5) and least deprived (Q1) MD quintile (P < 0.0001), and significant mediating effects for rtCGM and CSII use, but not isCGM. rtCGM use and CSII use accounted for 0.14% (P < 0.0001) and 0.25% (P < 0.0001) of the difference in HbA1c between patients from Q1 and Q5 quintiles (indirect effects), representing 12.0% and 23.1% of this difference, respectively. Conclusions: CSII and rtCGM use partially mediated the significant discrepancies observed with SES and glycemic management, highlighting potential benefits of broader access to these technologies to improve diabetes outcomes and help mitigate the negative impact of deprivation on diabetes management.

Keywords: Continuous glucose monitoring; Glycemic management; Insulin pump; Pediatric type 1 diabetes; Social determinants; Socioeconomic deprivation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Glucose
  • Blood Glucose Self-Monitoring
  • Child
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 1* / drug therapy
  • Glycated Hemoglobin
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Insulin / therapeutic use
  • Insulin Infusion Systems
  • Retrospective Studies
  • Social Class


  • Hypoglycemic Agents
  • Glycated Hemoglobin
  • Blood Glucose
  • Insulin