Inequalities in Access to Diabetes Technologies in Children with Type 1 Diabetes: A Multicenter, Cross-sectional Study from T��rkiye
Ka��an Ege Karaku��, Sibel Sakarya, Ruken Y��ld��r��m, ��ervan ��zalkak, Mehmet N ��zbek, Nurdan Y��ld��r��m, G��lcan Deliba��, Beray S Eklio��lu, Belma Halilo��lu, Murat Ayd��n, Heves K��rm��z��bekmez, Tu��ba G��k��e, Ecem Can, Elif Eviz, G��l Ye��iltepe-Mutlu, ����kr�� Hatun
Author Information
Ka��an Ege Karaku��: University of Colorado, Barbara Davis Center for Diabetes, Colorado, USA ORCID
Sibel Sakarya: Ko�� University Faculty of Medicine, Department of Public Health, ��stanbul, T��rkiye ORCID
Ruken Y��ld��r��m: Diyarbak��r Child Diseases Hospital, Clinic of Pediatric Endocrinology and Diabetes, Diyarbak��r, T��rkiye ORCID
��ervan ��zalkak: University of Health Sciences T��rkiye, Gazi Ya��argil Training and Research Hospital, Clinic of Pediatric Endocrinology and Diabetes, Diyarbak��r, T��rkiye ORCID
Mehmet N ��zbek: University of Health Sciences T��rkiye, Gazi Ya��argil Training and Research Hospital, Clinic of Pediatric Endocrinology and Diabetes, Diyarbak��r, T��rkiye ORCID
Nurdan Y��ld��r��m: University of Health Sciences T��rkiye, Ankara Dr. Sami Ulus Child Health and Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology and Diabetes, Ankara, T��rkiye ORCID
G��lcan Deliba��: ��ukurova University, Balcal�� Hospital Health Application and Research Center, Clinic of Pediatric Endocrinology and Diabetes, Adana, T��rkiye
Beray S Eklio��lu: Necmettin Erbakan University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Konya, T��rkiye ORCID
Belma Halilo��lu: Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, ��stanbul, T��rkiye ORCID
Murat Ayd��n: Ondokuz May��s University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, T��rkiye ORCID
Heves K��rm��z��bekmez: University of Health Sciences T��rkiye, ��mraniye Training and Research Hospital, Clinic of Pediatric Endocrinology and Diabetes, ��stanbul, T��rkiye ORCID
Tu��ba G��k��e: Ko�� University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, ��stanbul, T��rkiye ORCID
Ecem Can: Ko�� University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, ��stanbul, T��rkiye ORCID
Elif Eviz: Ko�� University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, ��stanbul, T��rkiye ORCID
G��l Ye��iltepe-Mutlu: Ko�� University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, ��stanbul, T��rkiye ORCID
����kr�� Hatun: Ko�� University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, ��stanbul, T��rkiye ORCID
Objective: To determine inequalities in access to diabetes technologies and the effect of socioeconomic factors on families with children with type 1 diabetes. Methods: In this multicenter, cross-sectional study, parents of children with type 1 diabetes completed a questionnaire about household sociodemographic characteristics, latest hemoglobin A1c (HbA1c) values, continuous glucose monitoring (CGM) and insulin pump use of children, the education and working status of parents. These characteristics were compared between technology use (only-CGM, only-pump, CGM+pump, no technology use). Results: Among 882 families, only-CGM users, only-pump users, and CGM+pump users were compared with no technology users, adjusting for age, sex, region, education levels, number of working parents, and household income. Children living in the least developed region had lower odds of having only-CGM [odds ratio (OR)=0.20, 95% confidence interval (CI): 0.12-0.34, p<0.001] and having CGM+pump (OR=0.07, 95% CI: 0.03-0.22, p<0.001) compared with those living in the most developed region. Children with parents who had not finished high school had lower odds of having only-CGM (mothers: OR=0.36, 95% CI: 0.19-0.66, p=0.001; fathers: OR=0.32, 95% CI: 0.18-0.60, p<0.001) or both CGM+pump (mothers: OR=0.27, 95% CI: 0.11-0.64, p=0.003; fathers: OR=0.34, 95% CI: 0.15-0.79, p=0.012) rather than no-technology compared to children whose parents have a university degree. Every $840 increase in the household income increased the odds by 5% for having only-CGM (OR=1.05, 95% CI: 1.02-1.09, p<0.001) or CGM+pump (OR=1.05, 95% CI: 1.01-1.08, p<0.001). Conclusion: Socioeconomic factors, such as parental education, region of residence, and income were associated with inequality in access to technologies. The inequalities are more prominent in access to CGM.
