Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Network Open, 8(8), e2528933. https://doi.org/10.1001/jamanetworkopen.2025.28933 Dr. Alzbeta Santova et al.
Points
- This extensive cross-sectional study examined the relationship between healthcare access and glycemic outcomes in 42,349 children with type 1 diabetes across 56 countries worldwide.
- Researchers found extreme global disparities, with 32 centers receiving full reimbursement for diabetes technologies, while centers in eight countries had no reimbursement for these essential supplies.
- Mean HbA1c levels were significantly lower in centers with full reimbursement for technologies and insulin compared to centers where patients had no access or financial support.
- The profound difference in glycemic control underscores how unequal access to modern diabetes management tools is a significant barrier to achieving global equity in patient outcomes.
- These findings serve as an urgent call for initiatives to close existing gaps and ensure universal accessibility to insulin and diabetes technologies for all affected children.
Summary
A new cross-sectional study aimed to investigate the relationship between global disparities in the accessibility and reimbursement of diabetes technologies and insulin, and glycemic outcomes in children with type 1 diabetes (T1D). The research collated data from 81 pediatric diabetes centers in 56 countries participating in the SWEET initiative. The study included glycated hemoglobin (HbA1c) levels from 42,349 children with type 1 diabetes (T1D) (52% male; mean age, 14.3 years; mean diabetes duration, 6.0 years), with data current as of December 31, 2023. Accessibility and reimbursement data for continuous glucose monitoring (CGM), insulin pumps (CSII), glucometers, and insulin were collected via web-based questionnaires.
The findings revealed significant global inequities. While 32 centers from 19 countries reported universal access with complete reimbursement for all technologies and insulin, eight countries reported no reimbursement for any of these essential resources. This disparity was strongly associated with glycemic outcomes. Centers with full reimbursement for all technologies and insulin reported mean HbA1c levels ranging from 7.62% (95% CI, 7.59%-7.64%) to 7.75% (95% CI, 7.73%-7.77%). In stark contrast, centers with no reimbursement or availability for these items showed mean HbA1c levels between 9.65% (95% CI, 9.55%-9.71%) and 10.49% (95% CI, 10.40%-10.58%), with the difference being statistically significant (P < .001 for all items).
The researchers concluded that unequal access to modern diabetes technologies and insulin represents a primary challenge to achieving global equity in pediatric diabetes outcomes. The study highlights a clear association between the level of reimbursement for diabetes care and mean center-level HbA1c. These data underscore the urgent need for global health initiatives to ensure universal and equitable access to essential diabetes supplies and technologies, thereby reducing disparities in glycemic control for children living with T1D worldwide.
Link to the article: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00388
References Santova, A., De Bock, M., Lanzinger, S., Goldbloom, E. B., Bratina, N., Barcala, C., Alhomaidah, D., Pande, A. R., Guness, P. K., Dzivite-Krisane, I., Limbert, C., Sumnik, Z., & SWEET Study Group. (2025). Global inequities in diabetes technology and insulin access and glycemic outcomes. JAMA Network Open, 8(8), e2528933. https://doi.org/10.1001/jamanetworkopen.2025.28933
