Racial Disparities in Diabetes Technology Use and Outcomes in Type 1 Diabetes in a Safety-Net Hospital

• Published in: Journal of diabetes science and technology Vol. 15; no. 5; pp. 1010 - 1017
• Main Authors: Fantasia, Kathryn L, Wirunsawanya, Kamonkiat, Lee, Christopher, Rizo, Ivania
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.09.2021
• Subjects: Adult; African Americans; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - ethnology; Glycated Hemoglobin A - analysis; Healthcare Disparities; Hispanic or Latino; Humans; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Insulin Infusion Systems; Retrospective Studies; Safety-net Providers; Special Section: Disparities in Diabetes Technology; Technology; Whites; type 1 diabetes mellitus; health care disparities; diabetes technology; safety-net hospital
• ISSN: 1932-2968; 1932-2968; 1932-3107
• DOI: 10.1177/1932296821995810

Background: Limited data exist regarding diabetes technology use among adults with type 1 diabetes (T1D) in urban racially/ethnically diverse safety-net hospitals. We examined racial/ethnic differences in the use of continuous glucose monitor (CGM) and continuous subcutaneous insulin infusion (CSII) in this setting. Methods: A retrospective review of 227 patients ≥ 18 years of age with T1D seen in an urban, safety-net endocrinology clinic during 2016-2017 was completed (mean age: 39; 80% English-speaking; 50% had public insurance). Diabetes technology use, defined as either CGM or CSII or both CGM and CSII, and clinical outcomes were examined by race/ethnicity. Results: Overall, 30% used CGM and 26% used CSII. After adjusting for age, language, insurance, and annual income, diabetes technology use in non-White patients was significantly lower than in White patients, predominantly lower in Black (aOR 0.25 [95% CI 0.11-0.56]) and patients identified as other race/ethnicity (aOR 0.30 [95% CI 0.11-0.77]). At the highest household income level (≥$75,000/y), Black and Hispanic individuals were significantly less likely than White individuals to use diabetes technology (P < .0007). Mean hemoglobin A1c (HbA1c) was lower in patients using any diabetes technology compared with patients using no technology (P < .0001). Use of CGM and CSII together was associated with the lowest HbA1c across all racial/ethnic groups. Conclusions: Racial/ethnic disparities in diabetes technology use and glycemic control were observed even after adjusting for sociodemographic factors. Further research should explore barriers to accessing diabetes technology in non-White populations.