Public Health System Funding for isCGM Reduces Socioeconomic Disparities in Type 2 Diabetes Control: A Cohort Study

Abstract

Objective: The objective of this study is to assess whether the provision of free intermittently scanned continuous glucose monitoring (isCGM) systems can reduce socioeconomic disparities in glycemic control among individuals with Type 2 diabetes mellitus (T2D) treated with multiple daily insulin injections. Methods: This is a cohort study involving 402 T2D patients from three hospitals, all of whom initiated isCGM use as part of routine clinical practice. The isCGM systems were provided free of charge through public healthcare funding, with no out-of-pocket cost to the patients. Glycated hemoglobin (HbA1c) levels were recorded before and after at least 3 months of sensor use. Socioeconomic status (SES) was determined based on the average annual net income per person within the census tract for each patient. Results: Prior to the sensor placement, the mean HbA1c was 8.9% for patients in the lowest SES quartile and 8.2% for those in the highest quartile (p = 0.009). Following isCGM implementation, significant HbA1c reductions were observed across all SES groups, with decreases of 1.0% in the lowest quartile and 0.6% in the highest (p < 0.001). Postintervention differences in HbA1c between SES quartiles were not statistically significant (p = 0.509). Conclusion: Public funding of isCGM systems is associated with a significant improvement in glycemic control and contributes to the reduction of pre-existing socioeconomic disparities in healthcare among T2D patients treated with insulin.