Persistent racial disparities exist among Black and non-Black individuals with type 1 diabetes. This study examines these disparities as they relate to the use of diabetes technology, such as insulin pumps.
Among children and adolescents with type 1 diabetes, there are racial disparities regarding the use of insulin pumps and continuous glucose monitors. These devices have been shown to improve clinical outcomes in some groups, so the rate at which they are used is an important determinant of the overall health of a cohort. These diabetes technologies are also associated with decreased frequency of severe hypoglycemia and diabetic ketoacidosis (DKA). Despite these major advances, racial disparities in the use of diabetes technology seem to have widened in the last decade. Black patients with type 1 diabetes are about half as likely to receive insulin pumps and continuous glucose monitors and have a threefold increased risk of hospitalizations with DKA and hypoglycemia. This study seeks to analyze the cause of these disparities among adult patients with type 1 diabetes.
Understanding the Multivariable Causes of Racial Disparities in Diabetes Technology Use
This study, published in the journal Diabetes Care, relied on retrospective data from a clinic-based cohort of adult patients with type 1 diabetes seen between April 2013 to January 2020. Race categories included non-Black (the reference group) and Black. The main outcomes were baseline and prevalent technology use, rates of diabetes technology discussions, and prescribing. Multivariable logistic regression analysis was used to evaluate the association of technology discussions and prescribing with race, adjusting for social determinants of health and diabetes outcomes. Extracted variables included demographics; social determinants of health such as language, marital status, and insurance type; mental health issues; substance use; past diabetes outcomes; and number of clinic visits.
Black Individuals with Type 1 Diabetes Face Consistently Worse Outcomes
Among 1,258 adults with type 1 diabetes, baseline technology use was significantly lower for Black patients compared to non-Black patients, at 7.9% vs. 30.3% for glucose monitors and 18.7% vs. 49.6% for insulin pumps, respectively. Among the Black participants, neighborhood context, insurance, marital status, and employment status all correlated with negative health outcomes and increased negative health risks. Black adults exhibited worse outcomes for nearly all health-related measures that were examined. Potential mechanisms for the persistent racial disparities in diabetes care include clinical practice requirements related to diabetes self-management skills and factors that influence the process of shared decision-making, including the doctor–patient relationship. Future studies should seek to understand the impact of provider type, training, and racial concordance between patients and providers on technology use and other health outcomes.
Kanbour, S., Jones, M., Abusamaan, M. S., Nass, C., Everett, E., Wolf, R. M., Sidhaye, A., & Mathioudakis, N. (2023). Racial Disparities in Access and Use of Diabetes Technology Among Adult Patients With Type 1 Diabetes in a U.S. Academic Medical Center. Diabetes Care, 46(1), 56-64. https://doi.org/10.2337/dc22-1055