{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T03:49:34Z","timestamp":1792900174028,"version":"4.5.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Advanced diabetes technologies such as continuous glucose monitoring (CGM), continuous subcutaneous insulin infusion (insulin pumps [CSII]), and glucometers alongside insulin access represent the criterion standard for managing type 1 diabetes (T1D) in children. Global disparities in their access and reimbursement may be associated with glycemic outcomes.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n To describe how accessibility and reimbursement of advanced diabetes technologies and insulin are associated with glycated hemoglobin (HbA\n 1c<\/jats:sub>\n ) levels in centers participating in the SWEET initiative, an international pediatric diabetes registry.\n <\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n \n This global multicenter cross-sectional study collected data from 81 centers in 56 countries. Web-based questionnaires were distributed to representatives of all 121 pediatric diabetes centers participating in the SWEET initiative from March 1 to May 31, 2024, and used to map accessibility of and reimbursement for CGM, CSII, glucometers, and insulin. Reimbursement data were compared with HbA\n 1c<\/jats:sub>\n levels using the SWEET Study dataset. Participants included 42\u202f349 children with T1D.\n <\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Responses were categorized into 4 groups based on the extent of reimbursement for diabetes technologies and insulin.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n Mean HbA\n 1c<\/jats:sub>\n levels across centers calculated from measurements current as of December 31, 2023, analyzed by categories of accessibility of and reimbursement for diabetes technologies and insulin.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Data collected from 81 of 121 SWEET centers (67%) across 56 countries included HbA\n 1c<\/jats:sub>\n levels from 42\u202f349 children with T1D (22\u202f021 male [52%]; mean [SD] age, 14.3 [4.4] years; mean [SD] diabetes duration, 6.0 [4.2] years). Universal access with complete reimbursement for all technologies and insulin was reported by 32 centers from 19 countries, while 8 countries reported no reimbursement for any technologies or insulin. Centers with full reimbursement for CSII, CGM, glucometers, and insulin showed mean HbA\n 1c<\/jats:sub>\n levels of 7.62% (95% CI, 7.59%-7.64%) to 7.75% (95% CI, 7.73%-7.77%) compared with 9.65% (95% CI, 9.55%-9.71%) to 10.49% (95% CI, 10.40%-10.58%) in centers with no reimbursement and\/or no availability (\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001 for all items).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n \n This cross-sectional study found that HbA\n 1c<\/jats:sub>\n levels were associated with the accessibility of modern diabetes technologies and insulin. Efforts to ensure universal accessibility are required to reduce global inequities and glycemic outcomes for children with T1D.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.28933","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:31:11Z","timestamp":1756308671000},"page":"e2528933","source":"Crossref","is-referenced-by-count":26,"title":["Global Inequities in Diabetes Technology and Insulin Access and Glycemic Outcomes"],"prefix":"10.1001","volume":"8","author":[{"given":"Alzbeta","family":"Santova","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Motol University Hospital and Second Faculty of Medicine, Prague, Czechia"},{"name":"First Faculty of Medicine, Charles University, Prague, Czechia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"de Bock","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Otago, Christchurch, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Lanzinger","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany"},{"name":"German Center for Diabetes Research, Munich-Neuherberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen B.","family":"Goldbloom","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada"},{"name":"Division of Endocrinology, Children\u2019s Hospital of Eastern Ontario, Ottawa, Canada"},{"name":"Children\u2019s Hospital of Eastern Ontario Research Institute, Ottawa, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasa","family":"Bratina","sequence":"additional","affiliation":[{"name":"Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children\u2019s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Consuelo","family":"Barcala","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Diabetes, Hospital de Pediatr\u00eda S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doha","family":"Alhomaidah","sequence":"additional","affiliation":[{"name":"Pediatric Endocrine and Diabetes Unit, Pediatric Department, Farwaniya Hospital, Al Farwaniyah Governorate, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arunkumar R.","family":"Pande","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Health City Vistaar Hospital, Lucknow, India"},{"name":"Department of Endocrinology, Diabetes and Metabolism, Lucknow Endocrine Diabetes and Thyroid Clinic, Lucknow, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pravesh Kumar","family":"Guness","sequence":"additional","affiliation":[{"name":"T1Diams, Quatre Bornes, Mauritius"},{"name":"Medecine de Semaine Diab\u00e9tologie, Groupe Hospitalier Est Reunion, Saint Benoit, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iveta","family":"Dzivite-Krisane","sequence":"additional","affiliation":[{"name":"Children\u2019s Endocrinology Unit, Children\u2019s University Hospital and Riga Stradi\u0146\u0161 University, Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catarina","family":"Limbert","sequence":"additional","affiliation":[{"name":"Unit of Pediatric Endocrinology and Diabetes, Hospital Dona Estefania, Lisbon, Portugal"},{"name":"Comprehensive Health Research Centre, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zdenek","family":"Sumnik","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Motol University Hospital and Second Faculty of Medicine, Prague, Czechia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"SWEET Study 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