Global Gaps in Diabetes Technology, Insulin Linked to Poor Outcomes

Children with type 1 diabetes (T1D) worldwide face unequal access to insulin and advanced diabetes technologies such as pumps and continuous glucose monitors (CGMs), according to a new global study.1 Among a cohort of pediatric patients across 56 countries, researchers found that centers with universal reimbursement for these resources achieved markedly better hemoglobin A1c (HbA1c) outcomes compared with those lacking access, underscoring the urgent need for global action to close disparities in diabetes care.

A study of children with type 1 diabetes (T1D) reveals major disparities in access to insulin and modern technologies, with significant impacts on glycemic control. | Image credit: habrovich - stock.adobe.com

This multicenter cross-sectional study is published in JAMA Network Open.

“This study reveals substantial disparities in the accessibility and reimbursement of diabetes technologies and insulin for children with T1D, depending on their continent and country of residence,” wrote the researchers of the study. “These differences are closely linked to variations in glycemic outcomes.”

Advances in diabetes technology have transformed the management of T1D, helping more youths and adults achieve healthier blood sugar levels.2 However, access to these tools is far from equal. A large US study found that while use of CGMs and pumps rose sharply between 2009 and 2023, overall glycemic control remained low, and racial, ethnic, and socioeconomic disparities persisted or even widened. Hispanic, non-Hispanic Black, and Medicaid-insured patients consistently had the lowest rates of both technology use and glycemic control, underscoring the ongoing inequities in diabetes care.

In this global study, researchers analyzed data from 81 pediatric diabetes centers in 56 countries participating in the SWEET initiative. From March to May 2024, centers completed web-based questionnaires detailing accessibility and reimbursement for insulin, CGMs, insulin pumps (CSII), and glucometers. Responses were categorized into 4 groups based on the extent of reimbursement, ranging from full coverage to no reimbursement. These data were then linked with glycated HbA1c levels from 42,349 children with T1D, current as of December 31, 2023. Mean HbA1c values were compared across reimbursement categories to assess the association between access to diabetes technologies and glycemic outcomes.

Among the 81 centers surveyed, only 32 centers across 19 countries reported universal access with full reimbursement for insulin and all technologies, while 8 countries reported no reimbursement at all. Children treated in centers with full reimbursement for CSII, CGM, glucometers, and insulin achieved mean HbA1c levels between 7.62% (95% CI, 7.59%-7.64%) and 7.75% (95% CI, 7.73%-7.77%), compared with significantly higher mean HbA1c levels of 9.65% (95% CI, 9.55%-9.71%) to 10.49% (95% CI, 10.40%-10.58%) in centers with no reimbursement or availability (P < .001 for all).

However, the researchers noted limitations to the study. First, unmeasured factors such as cultural, nutritional, and clinic staffing differences may have influenced glycemic outcomes. Second, questionnaire-based data restricted causal conclusions, and some regions were underrepresented. Third, quality of life outcomes was not assessed, which could provide further insight into the impact of access to insulin and technologies.

Despite these limitations, the researchers believe these findings highlight a strong association between reimbursement policies and glycemic control, underscoring the impact of global inequities in diabetes care.

“While some countries advance toward comprehensive diabetes management, others still struggle with basic access to life-preserving insulin,” wrote the researchers. “This stark disparity underscores the urgent need for collective action. These data serve as a call to accelerate ongoing initiatives and inspire new, innovative solutions aimed at closing these gaps. Only by addressing these inequities can we ensure that every child with diabetes, regardless of their geographic or socioeconomic status, has the same opportunity in diabetes care and diabetes outcomes.”

References

1. Santova A, de Bock M, Lanzinger S, et al. Global inequities in diabetes technology and insulin access and glycemic outcomes. JAMA Netw Open. 2025;8(8):e2528933. doi:10.1001/jamanetworkopen.2025.28933

2. Steinzor P. Technology improves glycemic control in type 1 diabetes, but disparities widen. AJMC®. August 14, 2025. Accessed August 27, 2025. https://www.ajmc.com/view/technology-improves-glycemic-control-in-type-1-diabetes-but-disparities-widen