- ✓Public CGM funding in Quebec reduced but did not eliminate access disparities
- ✓Both CGMs and insulin pumps were linked to better long-term blood sugar control (HbA1c)
- ✓Findings highlight fixable, policy-driven barriers rather than purely medical ones
| Journal | Diabetes, obesity & metabolism |
| Year | 2025 |
| Authors | Khodabandehloo, Fakembe, Senga |
| PMID | 40302106 |
What Was Studied and Why It Matters
Researchers in Quebec, Canada wanted to understand whether factors like income, race, education, and insurance type affect who actually gets to use modern diabetes technology — specifically insulin pumps and continuous glucose monitors (CGMs). This matters because these devices can meaningfully improve blood sugar control, yet they aren't equally available to everyone who needs them.
The study analyzed data from nearly 2,400 adults with type 1 diabetes (T1D) collected between 2019 and 2023. Quebec offers public funding for CGMs but not for insulin pumps, making it a useful real-world setting to see whether government coverage levels the playing field.
What the Researchers Found
Overall, about 37% of participants used insulin pumps and 82% used CGMs. But when researchers looked closer, clear gaps emerged:
- Insulin pump use was significantly lower among people earning under $80,000 per year, those without a post-secondary (college or university) education, non-White individuals, and those on public insurance.
- CGM use was lower mainly among lower-income individuals and those on public insurance — but the gap was smaller than for insulin pumps, likely because Quebec funds CGMs publicly.
- The more disadvantages a person faced, the less likely they were to use either technology. Each additional barrier compounded the others.
- Both insulin pumps and CGMs were linked to better HbA1c (a measure of average blood sugar over time), but not to differences in dangerous low blood sugar episodes or diabetes-related hospital visits.
What This Means for Real Patients
If you or a loved one has type 1 diabetes and isn't currently using a CGM or insulin pump, the reason may have less to do with medical eligibility and more to do with financial or social barriers. This is an important distinction — it means the problem is fixable through policy and support programs, not just personal choice.
Public funding for CGMs in Quebec did help reduce some of the inequality, showing that coverage programs work. However, insulin pumps — which remain unfunded — showed much steeper disparities, especially along racial and income lines.
For patients managing supplies and costs, working with a trusted diabetes supplier like MDS Diabetes can help you navigate your options for CGM sensors, insulin pump supplies, and other essentials — especially if you're trying to manage expenses carefully.
Why Automated Insulin Delivery Makes This Urgent
Diabetes guidelines are increasingly recommending automated insulin delivery (AID) systems — which combine pumps and CGMs to automatically adjust insulin. If disadvantaged groups can't access these tools, health gaps will widen as technology advances. The researchers call for targeted strategies to bring these devices to underserved communities.
Bottom Line
Social factors like race, income, and insurance type significantly reduce access to life-improving diabetes technology in type 1 diabetes. Public funding for CGMs helped narrow — but didn't eliminate — these gaps. Greater equity efforts are urgently needed, particularly for insulin pumps and the growing category of automated insulin delivery systems. If cost or access is a barrier for you, speak with your care team and explore support programs or trusted suppliers like MDS Diabetes for affordable supply options.