IMPORTANCE: 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. OBJECTIVE: To describe how accessibility and reimbursement of advanced diabetes technologies and insulin are associated with glycated hemoglobin (HbA1c) levels in centers participating in the SWEET initiative, an international pediatric diabetes registry. DESIGN, SETTING, AND PARTICIPANTS: 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 HbA1c levels using the SWEET Study dataset. Participants included 42 349 children with T1D. EXPOSURES: Responses were categorized into 4 groups based on the extent of reimbursement for diabetes technologies and insulin. MAIN OUTCOMES AND MEASURES: Mean HbA1c 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. RESULTS: Data collected from 81 of 121 SWEET centers (67%) across 56 countries included HbA1c levels from 42 349 children with T1D (22 021 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 HbA1c 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 (P < .001 for all items). CONCLUSIONS AND RELEVANCE: This cross-sectional study found that HbA1c 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.

1st Faculty of Medicine Charles University Prague Czechia

Children's Endocrinology Unit Children's University Hospital and Riga Stradiņš University Riga Latvia

Children's Hospital of Eastern Ontario Research Institute Ottawa Canada

Comprehensive Health Research Centre NOVA Medical School NOVA University of Lisbon Lisbon Portugal

Department of Endocrinology Diabetes and Metabolism Health City Vistaar Hospital Lucknow India

Department of Endocrinology Diabetes and Metabolism Lucknow Endocrine Diabetes and Thyroid Clinic Lucknow India

Department of Nutrition and Diabetes Hospital de Pediatría S A M 1 C Prof Dr Juan P Garrahan Buenos Aires Argentina

Department of Pediatric Endocrinology Diabetes and Metabolic Diseases University Children's Hospital University Medical Centre Ljubljana Ljubljana Slovenia

Department of Pediatrics Faculty of Medicine University of Ottawa Ottawa Ontario Canada

Department of Pediatrics Motol University Hospital and 2nd Faculty of Medicine Prague Czechia

Department of Pediatrics University of Otago Christchurch New Zealand

Division of Endocrinology Children's Hospital of Eastern Ontario Ottawa Canada

German Center for Diabetes Research Munich Neuherberg Germany

Institute of Epidemiology and Medical Biometry Ulm University Ulm Germany

Medecine de Semaine Diabétologie Groupe Hospitalier Est Reunion Saint Benoit France

Pediatric Endocrine and Diabetes Unit Pediatric Department Farwaniya Hospital Al Farwaniyah Governorate Kuwait

T1Diams Quatre Bornes Mauritius

Unit of Pediatric Endocrinology and Diabetes Hospital Dona Estefania Lisbon Portugal

doi: 10.1001/jamanetworkopen.2025.28941 PubMed

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