Auzanneau, Marie and Eckert, Alexander J. and Meyhöfer, Sebastian M. and Heni, Martin and Gillessen, Anton and Schwettmann, Lars and Jehle, Peter M. and Hummel, Michael and Holl, Reinhard W. (2023) Area deprivation and demographic factors associated with diabetes technology use in adults with type 1 diabetes in Germany. Frontiers in endocrinology, 14. pp. 1-9. ISSN 1664-2392

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Abstract

Introduction: Diabetes technology improves glycemic control and quality of life for many people with type 1 diabetes (T1D). However, inequalities in access to diabetes technology exist in many countries. In Germany, disparities in technology use have been described in pediatric T1D, but no data for adults are available so far. We therefore aimed to analyze whether demographic factors and area deprivation are associated with technology use in a representative population of adults with T1D. Materials and methods: In adults with T1D from the German prospective diabetes follow-up registry (DPV), we analyzed the use of continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), and sensor augmented pump therapy (SAP, with and without automated insulin delivery) in 2019-2021 by age group, gender, migration background, and area deprivation using multiple adjusted regression models. Area deprivation, defined as a relative lack of area-based resources, was measured by quintiles of the German index of Multiple Deprivation (GIMD 2015, from Q1, least deprived, to Q5, most deprived districts). Results: Among 13,351 adults with T1D, the use of technology decreased significantly with older age: CSII use fell from 56.1% in the 18−<25-year age group to 3.1% in the ≥80-year age group, CGM use from 75.3% to 28.2%, and SAP use from 45.1% to 1.5% (all p for trend <0.001). The use of technology was also significantly higher in women than in men (CSII: 39.2% vs. 27.6%; CGM: 61.9% vs. 58.0%; SAP: 28.7% vs. 19.6%, all p <0.001), and in individuals without migration background than in those with migration background (CSII: 38.8% vs. 27.6%; CGM: 71.1% vs. 61.4%; SAP: 30.5% vs. 21.3%, all p <0.001). Associations with area deprivation were not linear: the use of each technology decreased only from Q2 to Q4. Discussion: Our real-world data provide evidence that higher age, male gender, and migration background are currently associated with lower use of diabetes technology in adults with T1D in Germany. Associations with area deprivation are more complex, probably due to correlations with other factors, like the higher proportion of migrants in less deprived areas or the federal structure of the German health care system.

Item Type:	Article
Uncontrolled Keywords:	Type 1 diabetes, adults, diabetes technology, CGM, pump, age, gender, deprivation
Subjects:	Technology, medicine, applied sciences > Medicine and health
Divisions:	Faculty of Medicine and Health Sciences > Department of Public Health and Medical Education
Date Deposited:	20 Sep 2023 08:52
Last Modified:	28 Sep 2023 09:25
URI:	https://oops.uni-oldenburg.de/id/eprint/5851
URN:	urn:nbn:de:gbv:715-oops-59321
DOI:	10.3389/fendo.2023.1191138
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