Delayed Access to Diabetes Technology in Children With Migration Background: A Cross-Sectional Study on Treatment Equity in Austria
Author(s)
Marjan Arvandi1, Dagmar Meraner, MD2, Veronika Haslwanter, MSc.3, Sibylle Puntscher, PhD3, Uwe Siebert, MPH, MSc, ScD, MD4, Sabine Hofer, MD2, Daniela Schmid, PhD5.
1Senior Scientist, UMIT, Hall i. Tirol, Austria, 2Department of Pediatrics 1, Medical University of Innsbruck, Innsbruck, Austria, Innsbruck, Austria, 3UMIT TIROL, Hall in Tirol, Austria, 4UMIT TIROL - University for Health Sciences and Technology; Harvard Chan School of Public Health, Hall in Tirol, Austria, 5Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology,, Hall i. Tirol, Austria.
1Senior Scientist, UMIT, Hall i. Tirol, Austria, 2Department of Pediatrics 1, Medical University of Innsbruck, Innsbruck, Austria, Innsbruck, Austria, 3UMIT TIROL, Hall in Tirol, Austria, 4UMIT TIROL - University for Health Sciences and Technology; Harvard Chan School of Public Health, Hall in Tirol, Austria, 5Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology,, Hall i. Tirol, Austria.
OBJECTIVES: Children and adolescents with Type 1 Diabetes (T1D) and a migration background (MB) have been reported to experience disparities in access to advanced diabetes technologies. This study assessed differences in insulin pump and automated insulin delivery (AID) use, as well as glycemic control, between patients with and without MB in Tyrol, Austria.
METHODS: We conducted a cross-sectional study including children and adolescents aged 4-19 years with T1D duration ≥1 year, receiving care at a single tertiary center. Migration background was defined as having both parents born abroad. Data on treatment modalities, glycemic control (HbA1c), and complications were extracted from routine clinical records and supplemented by questionnaire data on socio-demographic and lifestyle factors. Group differences were analyzed using appropriate statistical tests. Logistic regressions were used to examine associations between MB and treatment outcomes, adjusting for potential confounders.
RESULTS: Among 143 participants (mean age 13.2 ± 3.7(standard deviation) years; 44.8% female), 24.5% had MB. At diagnosis, 50.0% of children without MB used insulin pump therapy compared to 28.6% with MB (p = 0.027). At study enrollment, pump or AID use increased to 76.8% in the non-MB group and 60.0% in the MB group (p = 0.052), indicating a catch-up effect. No statistically significant differences were found in HbA1c, continuous glucose monitoring use, or rates of diabetic ketoacidosis and severe hypoglycemia. Crude and adjusted models including different combinations of age, sex, physical activity, health, and living situation showed no significant association between MB and suboptimal glycemic control (defined as HbA1c >7%) (odds ratios [95%-confidence Interval]: 1.44[0.61-3.40] to 1.66[0.72-3.83]).
CONCLUSIONS: Children with MB had delayed access to insulin pump therapy at disease onset. Although disparities decreased over time, the initial gap highlights the need for early, targeted interventions to promote equitable access to diabetes technology for all pediatric patients.
METHODS: We conducted a cross-sectional study including children and adolescents aged 4-19 years with T1D duration ≥1 year, receiving care at a single tertiary center. Migration background was defined as having both parents born abroad. Data on treatment modalities, glycemic control (HbA1c), and complications were extracted from routine clinical records and supplemented by questionnaire data on socio-demographic and lifestyle factors. Group differences were analyzed using appropriate statistical tests. Logistic regressions were used to examine associations between MB and treatment outcomes, adjusting for potential confounders.
RESULTS: Among 143 participants (mean age 13.2 ± 3.7(standard deviation) years; 44.8% female), 24.5% had MB. At diagnosis, 50.0% of children without MB used insulin pump therapy compared to 28.6% with MB (p = 0.027). At study enrollment, pump or AID use increased to 76.8% in the non-MB group and 60.0% in the MB group (p = 0.052), indicating a catch-up effect. No statistically significant differences were found in HbA1c, continuous glucose monitoring use, or rates of diabetic ketoacidosis and severe hypoglycemia. Crude and adjusted models including different combinations of age, sex, physical activity, health, and living situation showed no significant association between MB and suboptimal glycemic control (defined as HbA1c >7%) (odds ratios [95%-confidence Interval]: 1.44[0.61-3.40] to 1.66[0.72-3.83]).
CONCLUSIONS: Children with MB had delayed access to insulin pump therapy at disease onset. Although disparities decreased over time, the initial gap highlights the need for early, targeted interventions to promote equitable access to diabetes technology for all pediatric patients.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
PCR55
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Patient-Centered Research
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), Pediatrics