Suboptimal adoption of diabetes technology despite coverage and the impact on glycemic outcomes in children and adolescents with type 1 diabetes in Hong Kong.

OBJECTIVES

Despite proven benefits of diabetes technologies in children with type 1 diabetes (T1DM), utilization varies globally. In Hong Kong, continuous glucose monitoring system (CGMS) uptake was low (10.6 %) in 2018; however reimbursement programs have been implemented since then to enhance accessibility. This study examined trends in diabetes technology adoption and glycemic outcomes from 2018 to 2023.

METHODS

The Hong Kong Childhood Diabetes Registry prospectively collected standardized data on all children with diabetes at age ≤18 years in public hospitals since 2018, and those with follow-up data between 2018 and 2023 were included. Regular CGMS use was defined as >80 % usage/year. Outcomes included mean HbA1c levels, incidence of diabetic ketoacidosis (DKA) and severe hypoglycemia. Clinical and psychosocial factors were compared between regular and non-regular CGMS users.

RESULTS

Mean HbA1c significantly decreased from 8.3 % in 2018 to 8.0 % in 2023 (p<0.05), with fewer children having HbA1c >9 % and a reduced rate of DKA. Regular CGMS use increased from 10.7 to 41.7 %, with highest adoption among school-aged children and lowest among adolescents. Compared to non-regular users, regular CGMS users demonstrated better glycemic outcome (mean HbA1c 7.6 vs. 8.2 %, p<0.05). There were no significant differences in rates of micro/macrovascular complications or severe hypoglycemic events between the two groups.

CONCLUSIONS

Despite improved glycemic outcomes and free access, CGMS adoption remained suboptimal in Hong Kong particularly among adolescents, indicating barriers beyond cost. Further research is needed to identify these barriers and develop targeted strategies to enhance technology use.