A new study led by researchers at the Johns Hopkins Bloomberg School of Public Health found big increases in the use of continuous glucose monitoring and insulin delivery devices by children and adults with type 1 diabetes over a 15-year period, with corresponding jumps in optimal blood-sugar control.
For their study , the researchers used a large national database of de-identified electronic health records to analyze nearly 200,000 individuals with type 1 diabetes across five three-year periods from 2009 to 2023. The research team tracked individuals' adoption of continuous glucose monitoring and insulin pump devices, as well as blood tests.
From the 2009–2011 period to the 2021–2023 period, the proportion of individuals under 18 with optimal glucose control rose from 7% to 19%—a 171% increase—while the proportion of adults with optimal control rose from 21% to 28%—a 33% increase. The researchers used a standard blood test for the percentage of hemoglobin bound by glucose (HbA1c) to measure glucose control. A test result below 7% is recommended to prevent long-term complications.
From the first period to the last period, the proportion of type 1 diabetes patients using continuous glucose monitoring devices rose from 4% to 82% among youths under 18—a more than twentyfold increase—and from 5% to 57% among adults—more than a tenfold increase. The proportion of patients using insulin pumps during these periods rose from 16% to 50% among youths and 11% to 29% among adults. The concurrent use of both devices also increased dramatically during this period, from 1% to 47% among youths and from 1% to 22% among adults.
The study was published online August 11 in JAMA Network Open.
"Improving glucose control in patients with type 1 diabetes has been challenging, so these big increases are exciting for the field," says study first author Michael Fang , PhD, MHS, an assistant professor in the Bloomberg School's Department of Epidemiology. "These improvements have likely been driven by the widespread adoption of new monitoring and delivery technologies."
About 2 million Americans, including 304,000 children and adolescents, have been diagnosed with type 1 diabetes, according to the American Diabetes Association. The once-fatal autoimmune disorder typically strikes in childhood when immune cells, often triggered by a viral infection, mistakenly attack and wipe out insulin-producing cells in the pancreas.
Insulin, discovered and introduced clinically in the 1920s, was a game-changer for individuals with type 1 diabetes. The standard treatment involved insulin injections after meals. This kept patients alive, but glucose control was not always stable or reliable. In recent decades, continuous blood glucose monitoring devices and insulin pumps have allowed patients to optimize blood glucose levels throughout the day.
The sample used for the analysis totaled 186,590 individuals with type 1 diabetes, including 159,737 adults and 26,853 patients under 18.
The findings varied by race and insurance type, with non-Hispanic white patients and those with commercial health insurance having higher rates of technology adoption and glucose control. Among individuals under 18 in the 2021–2023 period, 21% of non-Hispanic white patients had glucose control, versus 17% of Hispanic and 12% of non-Hispanic Black patients.
The researchers say that policies that make it easier for type 1 diabetes patients to access devices such as continuous glucose monitoring devices could help reduce these disparities.
"While we should be celebrating the improvements, we must remember that most patients with type 1 diabetes don't have optimal glucose control, and there is a lot of room for improvement," says study senior author Jung-Im Shin , MD, PhD, associate professor in the Bloomberg School's Department of Epidemiology.
The team plans to use the same vast health-records database for further studies of type 1 diabetes patients and trends in common complications such as cardiovascular and kidney disease.
" Trends and Disparities in Technology Use and Glycemic Control in Type 1 Diabetes " was co-authored by Michael Fang, Yunwen Xu, Shoshana Ballew, Josef Coresh, Justin Echouffo Tcheugui, Elizabeth Selvin, and Jung-Im Shin.
Support for the research was provided by the National Heart, Lung, and Blood Institute (K24 HL152440) and the National Institute for Diabetes and Digestive and Kidney Diseases (K01 DK138273, R01 DK115534, R01 DK139324).
