Children With Diabetes Around the Globe and Ready Access to Advanced Care Technologies

Type 1 diabetes is the most common form of diabetes in youths. 1 Evidence-based treatment for children with diabetes requires optimization of glycemic control with the goal of reducing the risk of microvascular complications and consequently extending the lifespan and improving quality of life.The International Society for Pediatric and Adolescent Diabetes (ISPAD) recommends that caregivers aim to achieve a hemoglobin A 1c level of less than 53 mmol/mol (<7.0%) 2 and that they use the most advanced insulin delivery technology available. 3Santova and colleagues 4 provide an assessment of global success in achieving this glycemic goal and a description of the technology used in the management of type 1 diabetes in children.These investigators performed a cross-sectional study that collated data about the accessibility of diabetes technologies and insulin from 81 centers across 56 countries and found an association between the accessibility of advanced technologies and insulin with overall hemoglobin A 1c level.Children who had full availability and reimbursement of technology and insulin had much lower hemoglobin A 1c levels than did those who had to pay out of pocket, and children who had limited reimbursement for diabetes supplies had levels of glucose control between the 2 extremes.Because this report included more than 40 000 children from developed and developing countries around the globe, it builds on what has been reported previously from the Czech national CENDA registry. 5This work challenges us to do better in providing care for all children with type 1 diabetes.It is striking that providing ready access to diabetes technology by itself is associated with improved glycemic control in children with diabetes.Optimal diabetes care requires the participation of a team of caregivers, including physicians, nurses, educators, dieticians, and mental health clinicians who focus on supporting behavior change, providing education, and implementation of complex regimens.During the past several decades, new insulins, technologies, and educational programs have been introduced into clinical practice with the goal of improving glycemic control.With each improvement, small gains in glycemic control were realized but no improvement has shown the benefit of the newest hybrid closed loop pumps that deliver insulin using an algorithm based on the minute-to-minute collection of indirect measures of blood glucose levels. 6The commitment of the care team to supporting patient-centered diabetes care probably has not changed over the decades, but the newest technologies provide tools to manage diabetes that surpass those available in the past.These tools are highly efficacious and relatively easy to use.When their use is supported by the multidisciplinary diabetes care team, real improvements in glycemic control have been seen, as demonstrated by Santova et al. 4 Access to diabetes care, like all medical care, is determined by the prevailing public policy in the country in which a patient lives.Changing public policy to provide universal access to diabetes technologies may be a heavy political lift, but it pales in comparison to the burdens experienced by patients who must manage their diabetes day in and day out for a lifetime.As our communities work to improve access to advanced technologies for diabetes care, we must also keep in mind that ready access does not by itself ensure that hemoglobin A 1c levels will be optimally controlled.ISPAD identifies social determinants of health as being a significant barrier in optimizing care in children with diabetes, and it will be important for caregivers to address such determinants in developing care plans for their patients.In addition, awareness of one's own racialand ethnicity-based implicit biases must be considered because they have been shown to play a role +