medwireNews: US researchers have identified racial disparities in the receipt of diabetes technologies among young adults with type 1 diabetes.
They found that Hispanic, and in particular non-Hispanic Black, people were markedly less likely to receive insulin pumps and continuous glucose monitoring (CGM) devices relative to White people.
“Minority patient preferences, health care provider implicit bias, mistrust of medical systems, and patient–provider relationships need to be more fully explored as contributors to disparities in insulin pump and CGM use,” say the researchers.
“In addition, systems-based, culturally tailored, and standardized approaches are needed to provide equal opportunities to obtain and use diabetes technology.”
The findings from Shivani Agarwal (Albert Einstein College of Medicine, New York, USA) and study co-authors are based on a national sample of 300 young adults (55% women), aged an average of 20 years, drawn from six T1D Exchange clinic network sites.
Of the 100 non-Hispanic White participants, 71% were using CGM and 72% had an insulin pump, the team reports in Diabetes Technology & Therapeutics.
But of the 103 Hispanic participants, only 37% and 39% were using CGM and pumps, respectively, and this fell to just 28% and 18%, respectively, among the 97 non-Hispanic Black participants.
Black and Hispanic participants had lower individual and neighborhood socioeconomic status than White participants, and the researchers had hypothesized that this would account for a large part of the racial disparities in diabetes technology use.
However, most disparities remained after accounting for socioeconomic status, as well as for factors including age, sex, health literacy, diabetes numeracy, and self-reported blood glucose monitoring frequency and clinic attendance.
Specifically, the adjusted rate of CGM use was 53% and 58% among White and Hispanic participants, respectively, but was just 31% for Black participants. The corresponding rates for insulin pump use were 61%, 49%, and 20%.
Black participants also had the worst glucose control, with an average glycated hemoglobin level of 10.5% (91 mmol/mol), compared with 8.6% (70 mmol/mol) for Hispanics and 8.1% (65 mmol/mol) for White participants.
“We were surprised that health literacy, numeracy, income, and insurance level did not significantly attenuate disparities,” write the researchers.
“Moreover, we did not expect clinical setting, clinic attendance, and self-monitoring of blood glucose to have such small associations with disparities in use, especially because there were large differences in these measures between the racial and ethnic groups.”
The team suggests this could be partly because some of these self-management factors were self-reported and therefore subject to inaccurate estimates. “However, it is also possible that there are unmeasured variables here that are more influential in technology disparities and need to be further studied.”
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