TOPLINE:
Children with type 1 diabetes (T1D) living in rural areas are significantly less likely than those in urban areas to complete diabetes care visits in which continuous glucose monitor (CGM) data are used as part of patient care.
METHODOLOGY:
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In a retrospective study of electronic health records from a single diabetes program between 2018 and 2021, researchers compared the odds of completing a visit with or without a CGM interpretation between regions designated as rural-urban communing areas (RUCAs).
TAKEAWAY:
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Among a total 2008 children with T1D seen, 67.5% (1356) had at least one encounter involving a CGM billing code.
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Of a total of 13,645 visits, 40.2% (5465) had a billing code for CGM interpretation.
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Overall, 68.2% (9308) of visits were completed by patients living in RUCA-designated urban areas, 21.3% (2907) were in large rural towns, 7.7% (1046) were in small rural towns, and 2.8% (384) were in isolated small rural towns.
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The odds of a CGM-billed visit were 31% lower among those living in small rural towns (odds ratio [OR], 0.69; P = .018) and 49% lower among those living in isolated small rural towns (OR, 0.51; P = .025) compared to those living in urban areas after adjusting for sex, race/ethnicity, A1c level, visit year, and insurance type.
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In both adjusted and unadjusted models, those with public insurance had significantly lower odds of CGM use during clinic visits than those with private insurance (adjusted OR, 0.58; P < .001).
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Black and Hispanic children had lower odds of CGM-billed visits compared to White children (OR, 0.48 and 0.54, respectively; both P < .001).
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Visits with CGM billing codes were associated with lower A1c levels (8.0% vs 9.3%).
IN PRACTICE:
“These data suggest that pediatric diabetes providers should be aware of the potential barriers to CGM use experienced by patients living in rural areas and attempt to work together with patients to identify and develop strategies to overcome these barriers to optimal diabetes care.”
SOURCE:
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The study was conducted by Daniel R. Tilden, MD, of the Division of Endocrinology, Diabetes and Clinical Genetics, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, and colleagues.
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It was published October 31, 2023, in Diabetes Care.
LIMITATIONS:
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Billing codes may not be accurate.
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Technical difficulties in downloading data may have prevented coding.
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Some patients may have moved.
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The COVID-19 pandemic interfered with clinical care.
DISCLOSURES:
The study was funded by the National Institutes of Health, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Vanderbilt Diabetes Research and Training Center. The authors have disclosed no further financial relationships.
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