Treating Diabetes with CGMs in Rural Areas

Type 1 diabetes is significantly more prevalent in rural communities than in urban areas. Daniel Tilden M.D, MPH, Assistant Professor of Endocrinology, Diabetes, and Clinical Pharmacology at the University of Kansas Medical Center, is conducting a study to look at the use of Continuous Glucose Monitors (CGM) by adults, children, and adolescents especially in rural communities.

CGMs are wearable sensor based devices that enable people to monitor their glucose blood sugar which includes rural children and adolescents living with type 1 diabetes. CGMs are able to send glucose readings to the wearer's smartphone or to other devices, and then send the glucose readings directly to a healthcare provider.

Previous studies examining the use of CGMs by children relied on prescription records to identify use of these devices, but just because someone in prescribed a CGM does not always mean they use one. In addition, the cost of the CGM may be a problem.

In a new study published in "Diabetes Care". Dr. Tilden and his colleagues studied EHRs for more than 2,000 children younger than 18 years of age with type 1 diabetes from 2018 through 2021.

The results produced a sizable disparity. Those in general living in rural areas were significantly less likely to use a CGM than people living in urban areas. The use of CGMs were 31% lower for children and adolescents living in small rural towns, and 49% lower for those living in isolated rural towns. The gap and disparities existing between rural and urban patients persisted across the four year study.

According to Dr. Tilden, "More research is needed to explore the reasons for these disparities in rural communities, but likely issues such as cost, reduced internet access which CGMs require in order to rely their data, plus long distances from clinics, and Medicaid contracted pharmacies can be a real problem."

To move forward and help solve the problem of using CGMs in rural communities, Dr. Tilden is currently seeking funding to design an intervention that uses telemedicine to be able to partner with a network of 35 clinics across Kansas especially geared to delivering specialty care to diabetes patients in rural areas.