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.

• MeSH
• Global Health MeSH
• Diabetes Mellitus, Type 1 * drug therapy   blood   MeSH
• Healthcare Disparities * statistics & numerical data   MeSH
• Child MeSH
• Health Services Accessibility * statistics & numerical data   MeSH
• Glycated Hemoglobin analysis   MeSH
• Hypoglycemic Agents * therapeutic use   MeSH
• Insulin * therapeutic use   economics   administration & dosage   MeSH
• Insulin Infusion Systems * economics   statistics & numerical data   MeSH
• Blood Glucose analysis   MeSH
• Humans MeSH
• Adolescent MeSH
• Cross-Sectional Studies MeSH
• Glycemic Control MeSH
• Blood Glucose Self-Monitoring economics   statistics & numerical data   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Names of Substances
• Glycated Hemoglobin MeSH
• Hypoglycemic Agents * MeSH
• Insulin * MeSH
• Blood Glucose MeSH