Racial Disparities Persist in CGM Use, HbA1c | ADA 2025
Researchers presented an abstract describing current racial disparities in CGM access and wear time to better inform quality improvement efforts.
Racial disparities in hemoglobin A1c (HbA1c) and continuous glucose monitor (CGM) use persist as Black and Hispanic youth report poorer outcomes when compared with White teens.
Aside from disparities in HbA1c and overall CGM use, researchers uncovered inequities in CGM wear time and access, according to an abstract presented at the American Diabetes Association’s 85th Scientific Sessions, held in Chicago, Illinois, from June 20-23, 2025.1
“Inequities in CGM use contribute to health disparities among teens with type 1 diabetes (T1D),” wrote authors of the abstract. “Recent changes in insurance coverage and standards of care may have reduced systemic barriers to CGM access.”
To better understand disparities in CGM use and access, researchers explored electronic health records of 402 teens with T1D. | image credit: Mediaphotos / stock.adobe.com
According to authors of a study published in the Journal of General Internal Medicine, CGMs have previously been established as the standard of care for patients with T1D tracking their blood glucose levels. Among those with T1D, at least 40% are using CGMs.2 Despite CGM use evolving significantly within the history of diabetes care, disparities in access and use are common, similar to many other areas of the health care sector.
READ MORE: CGM Usage Improves Glycemic, Psychosocial Outcomes for Type 1 Diabetes | ADA 2025
“Racial/ethnic and socioeconomic disparities have been reported across all facets of health care quality and outcomes. In diabetes, these disparities have been associated with higher levels of morbidity and mortality,” wrote authors of a study published in Diabetes Technology & Therapeutics.3 “Although numerous studies have shown significant advantages of CGM use over traditional BGM in improving glycemic control and reducing diabetes-related hospitalizations and emergency room service utilization, this technology is underutilized in historically marginalized pediatric and adult populations.”
With previous disparities in mind, especially in teens with T1D, authors of the current study aimed to determine if these inequities have persisted given trends in insurance coverage and standards of care in such a prevalent disease.1 As an update to previous studies that explored disparities in CGM use, researchers specifically described the current inequities in CGM access and wear time. Furthermore, they included race and ethnicity, as well as type of insurance, to better understand these disparities, inform future research, and advance quality improvement measures.
To better understand disparities in CGM use and access, researchers explored electronic health records of 402 teens with T1D (mean age, 14 years; 52% boys). All participants attended an endocrinology appointment at a US children’s hospital from April 2023 to April 2024.
For a full breadth of these disparities and of the study population, researchers collected a variety of data points from the youth participants. “We extracted data on race, ethnicity, sex, insurance, access to CGM, past 14-day CGM wear time (percentage), HbA1c, and age and duration of diagnosis,” they wrote.1
Researchers reported that 97% of the study population had access to CGMs, wearing them on average 86% of the past 14 days. Diving into disparities uncovered in the study, researchers identified differences between White teens and minority groups in HbA1c, insurance coverage, access to CGM, and CGM wear time.
White participants had lower HbA1c than Black and Hispanic youth, with White youth reporting HbA1c at 7.5%, Black participants at 9.6%, and Hispanic youth at 8.7%. HbA1c was also higher among participants with public insurance compared with private insurance.
Strictly comparing White and Black participants, 6% more White youth had access to CGM than those that were Black. Black and Hispanic youth participants also used CGM less than White participants.
“A number of potential factors are driving these disparities, including access to quality care, physician shortages, restrictive insurance eligibility criteria, and implicit bias among health care professionals,” continued authors of the Diabetes Technology & Therapeutics study.3 “Potential solutions to address these barriers include advocacy efforts to expand CGM coverage, expansion of the care team by utilizing community health workers and telehealth services, and individualization of care with coordinated follow-up after device initiation.”
While overall access to health care is crucial for patients of all races and backgrounds, evidence shows that CGM access has significant progress to make. From advocacy efforts to a more personalized approach between patients and providers, there are many opportunities for health care professionals to make a difference and ameliorate some of these persistent disparities.
“Our findings extend the literature by demonstrating inequities in CGM wear time,” concluded the authors.1 “Future research aiming to promote health equity may benefit from improving CGM wear time as well as CGM access.”
Read more from our coverage of the ADA’s 85th Scientific Sessions.
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