Diabetes technology in pregnancy: a call to address global inequity

Introduction

Diabetes technology plays a vital role in managing diabetes during pregnancy, especially for women who already have diabetes or develop it during pregnancy. Unfortunately, there is a significant global disparity in access to these essential technologies, which can negatively affect the health of both mothers and their babies.

Context of Diabetes in Pregnancy

The International Diabetes Federation (IDF) reports that about 1 in 7 births around the world is impacted by high blood sugar levels during pregnancy, encompassing both pre-existing and gestational diabetes. Proper management is essential, as uncontrolled diabetes can lead to serious complications such as preterm births, larger-than-average babies, and a higher likelihood of cesarean sections. Utilizing advanced diabetes technologies, like continuous glucose monitors (CGMs) and insulin pumps, can greatly enhance blood sugar control and minimize risks.

Timeline of Diabetes Technology Development

• 1980s: The launch of insulin pumps transformed diabetes management by allowing for more accurate insulin delivery.
• 1999: The first CGM device received approval, enabling real-time monitoring of glucose levels.
• 2010s: Technological advancements led to hybrid closed-loop systems, which automatically adjust insulin delivery based on glucose readings.
• 2020: The COVID-19 pandemic underscored the existing disparities in access to diabetes technology, with many women unable to secure necessary devices due to disruptions in healthcare services.

Current State of Diabetes Technology in Pregnancy

Even with significant advancements in diabetes technology, access remains inconsistent across various regions and socioeconomic groups. Women in high-income countries generally have better access to these tools, while those in low- and middle-income countries encounter substantial obstacles.

Key Facts

• Access Disparities: In wealthier nations, over 70% of pregnant women with diabetes utilize some form of diabetes technology. Conversely, this figure can drop to as low as 10% in low-income countries.
• Cost: The expense of diabetes technologies, such as CGMs and insulin pumps, poses a significant barrier for many women. For instance, a CGM can cost over $1,000 per month, making it unaffordable for many families in low-income areas.
• Education and Training: Proper use of diabetes technology necessitates education and training, which are often lacking in underserved communities.

Implications of Inequity

The unequal access to diabetes technology during pregnancy has serious consequences. Women in low-resource settings may face higher rates of complications, leading to increased maternal and infant health issues. Additionally, the lack of access to these technologies can perpetuate health inequities, as children born to mothers with poorly managed diabetes are at a greater risk of developing obesity and type 2 diabetes later in life.

Health Outcomes

• Maternal Health: Women without access to diabetes technology are at a greater risk for complications like preeclampsia and gestational hypertension.
• Infant Health: Babies born to mothers with uncontrolled diabetes face higher risks of congenital anomalies and other neonatal complications.

Conclusion

Addressing the global inequity in access to diabetes technology during pregnancy is crucial. As diabetes rates continue to climb worldwide, ensuring that all women have equitable access to these management tools is essential for improving health outcomes for both mothers and infants. If we fail to tackle this issue, the health disparities experienced by women in low- and middle-income countries will only continue to grow, affecting future generations.