Insurance Status and Neighborhood Resources Shape CGM Access During Pregnancy With Type 1 Diabetes

Continuous glucose monitors help pregnant people with type 1 diabetes track and manage their blood sugar more precisely—which is especially important during pregnancy. Yet not everyone has equal access to this technology. Researchers wanted to understand whether social and economic factors affect who gets to use CGMs during pregnancy.

This question is important because pregnancy with type 1 diabetes carries real health risks for both parent and baby. Better blood sugar control reduces those risks, and CGMs support better control. If some groups have harder access to CGMs, that could mean unequal health outcomes.

Researchers looked at 288 pregnancies with type 1 diabetes cared for at one large health system between 2016 and 2023. Half of these patients had public insurance, and half had private insurance.

The results showed a clear gap: 38.9% of publicly insured patients used CGMs, compared to 61.8% of privately insured patients. Even after accounting for age, BMI, and how long patients had diabetes, public insurance remained strongly linked to lower CGM use.

The study also examined neighborhood economic disadvantage using a measure called the Area Deprivation Index. Patients living in more economically disadvantaged neighborhoods were also less likely to use CGMs. Notably, whether patients lived in rural or urban areas did not significantly affect CGM use.

Over the study period from 2016 to 2023, CGM use increased overall—a positive trend. However, publicly insured patients consistently lagged behind. The gap was roughly two years: whatever level of CGM adoption private insurance patients reached in one year, publicly insured patients typically reached about two years later.

This delay matters during pregnancy, when timely access to the best tools for managing blood sugar can affect both parent and baby health.

The findings point to what researchers call 'social determinants of health'—the economic, social, and neighborhood factors that shape who gets access to medical care and tools. Public insurance status and living in an economically disadvantaged area were both linked to lower CGM use during pregnancy.

These barriers exist even though CGMs are proven to improve glycemic management in pregnancy. The researchers conclude that addressing these disparities should be part of improving diabetes care during pregnancy. This might mean looking at insurance coverage policies, healthcare system practices, or other factors that make CGMs harder to access for certain groups.

For patients and families, these findings highlight an important conversation to have with your pregnancy care team: if you're having trouble accessing a CGM, barriers may be at the system level, not personal. Asking about coverage options, assistance programs, or alternative pathways to CGM access is a reasonable step.

Source: Pregnancy (Hoboken, N.J.). Evidence type: PubMed indexed literature. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.