Diabetic medicine : a journal of the British Diabetic Association · 2026
Improving glycaemic outcomes with subsidised access to diabetes technology in a young adult population with type 1 diabetes.
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Lee Andrew-Hyun, Stokes Gabrielle, Farrell Kaye, Holmes-Walker Deborah Jane
Аннотация
AIMS: The availability of diabetes technologies has increased, although access can be limited for young people with type 1 diabetes (T1D). In Australia, access to subsidised continuous glucose monitors (CGM) has expanded significantly, while insulin pump access remains limited. This study evaluated the impact of changes in availability of diabetes technologies on glycaemic outcomes in young adults with T1D.
METHODS: 418 with T1D aged 15-25 years attending a young adult diabetes clinic in Sydney were reviewed between July 2019 and June 2024. The primary outcome was change in glycaemia as measured by glycosylated haemoglobin (HbA1c) across 5 years.
RESULTS: CGM use increased from 29.4% to 76.2% over the study duration, and uptake increased in all sociodemographic groups likely due to universal subsidisation. Insulin pump use remained unchanged (52-57%), as pump access remains limited by cost. An increase in pump therapy was only observed in those of the lowest sociodemographic cohort, attributed to expansions in the insulin pump program targeted to low-income households, although a reduction in usage was observed in middle socio-economic groups. Use of hybrid closed loop (HCL) insulin pumps increased from 5.1% to 35.4% in line with CGM uptake. With increased uptake of technologies, median HbA1c improved from 68 mmol/mol (8.4%) to 64 mmol/mol (8.0%) (p < 0.001). CGM and HCL demonstrated independent benefits to glycaemia. Rates of severe hypoglycaemia and diabetic ketoacidosis were low at 1.08 and 4.90/100 person-years, respectively. Pump therapy was associated with reduced DKA.
CONCLUSIONS: Overall, improvements in glycaemia in young adults were achieved with greater accessibility to subsidised diabetes technologies.
METHODS: 418 with T1D aged 15-25 years attending a young adult diabetes clinic in Sydney were reviewed between July 2019 and June 2024. The primary outcome was change in glycaemia as measured by glycosylated haemoglobin (HbA1c) across 5 years.
RESULTS: CGM use increased from 29.4% to 76.2% over the study duration, and uptake increased in all sociodemographic groups likely due to universal subsidisation. Insulin pump use remained unchanged (52-57%), as pump access remains limited by cost. An increase in pump therapy was only observed in those of the lowest sociodemographic cohort, attributed to expansions in the insulin pump program targeted to low-income households, although a reduction in usage was observed in middle socio-economic groups. Use of hybrid closed loop (HCL) insulin pumps increased from 5.1% to 35.4% in line with CGM uptake. With increased uptake of technologies, median HbA1c improved from 68 mmol/mol (8.4%) to 64 mmol/mol (8.0%) (p < 0.001). CGM and HCL demonstrated independent benefits to glycaemia. Rates of severe hypoglycaemia and diabetic ketoacidosis were low at 1.08 and 4.90/100 person-years, respectively. Pump therapy was associated with reduced DKA.
CONCLUSIONS: Overall, improvements in glycaemia in young adults were achieved with greater accessibility to subsidised diabetes technologies.