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Type 1 Diabetes

Who Gets Diabetes Tech? The Answer Isn't Fair

· 3 min read · Reviewed by GlucIQ Clinical Review Workflow
#equity#technology#cluster:equity

Two kids get diagnosed with type 1 the same week. One leaves the clinic with a CGM on their arm and a pump schedule booked. The other leaves with a prescription pad and a “let’s see how you do” — and studies show that split follows income and skin color, year after year (Adler et al., 2023).

This gap isn’t a fairness footnote. It’s a health issue playing out in slow motion. The people least likely to get a CGM are the people whose glucose is most likely to be off. The two aren’t unrelated.

What the research shows

Studies consistently find that diabetes technology use is lower among:

  • People from lower-income backgrounds — devices cost money, even with insurance.
  • People in certain racial and ethnic groups — a persistent gap documented across multiple registries.
  • People without strong tech or health-literacy support — the “setup and sustain” burden is real.

And critically: the same studies show the HbA1c gap follows the same lines (Adler et al., 2023). Who gets the tech and who doesn’t isn’t a side detail — it’s a driver of who lands in a healthy range.

Why the gap exists

It’s not one thing. It’s a stack:

  • Cost and coverage. Even with insurance, supplies add up.
  • The digital divide. Setup, apps, data sharing — they assume a certain level of tech comfort.
  • Clinic dynamics. Who gets offered a pump, and who gets a lecture about “not being ready,” isn’t always based on clinical need.
  • Structural barriers. Transport to appointments, time off work, language — all of it filters who gets the tech.

Why this matters to everyone

  • For people experiencing the gap: know that the barrier is structural, not personal. Not having a CGM isn’t a moral failing — and it’s worth pushing for, because the outcomes difference is real.
  • For advocates and clinicians: the research is a call to make tech access a priority — simplified programs, lower-cost options, and clinics that offer rather than gatekeep.
  • For the community: talking about the gap is part of closing it.

What you can do

  • If you don’t have a CGM and want one: ask. Repeatedly if needed. The research on outcomes is on your side.
  • Ask about assistance programs. Device makers have patient-assistance programs; your care team may know about local support.
  • If you work in or influence care: check your own clinic’s pattern. Who gets offered tech, and who doesn’t?

References

  • Adler E, et al. A decade of disparities in diabetes technology use and HbA1c in pediatric type 1 diabetes: a transatlantic comparison. Diabetes Care. 2023. DOI: 10.2337/dc22-0804