Race disparities persist in CGM use among children with type 1 diabetes
White children with type 1 diabetes are twice as likely to initiate continuous glucose monitoring and four times as likely to persist with therapy at 1 year compared with Black and Hispanic children, regardless of insurance type, data show.
“Many studies have shown that non-Hispanic Black children with type 1 diabetes are less likely to use continuous glucose monitors; we wanted to see if this was also the case in our center,” Colin P. Hawkes, MD, PhD, consultant pediatric endocrinologist at Cork University Hospital, Ireland, and adjunct assistant professor at the University of Pennsylvania Perelman School of Medicine, told Healio. “We also wanted to understand if this was related to less initiation of this technology or higher rates of discontinuation after starting to use it. This was important because we needed to know where to target any interventions to address disparities.”
In a retrospective review, Hawkes and colleagues analyzed data from 726 children with type 1 diabetes attending the Children’s Hospital of Philadelphia who initiated CGM from 2015 to 2018 (600 white; 85 Black; 41 Hispanic). Researchers assessed rates of CGM initiation and continued use at 1 year by race.
Within the cohort, white and Hispanic children were 54% and 31% more likely to initiate CGM, respectively, compared with Black children (P < .001). In analyses adjusted for insurance type, age at diagnosis and sex, the OR for white children initiating CGM was 2.2 (95% CI, 1.6-3) compared with Black children and 2 (95% CI, 1.3-3) compared with Hispanic children.
At 1 year after initiating therapy, fewer Black children were still using CGM compared with white and Hispanic children, with rates of 61%, 86% and 85%, respectively (P < .001).
Among those with commercial insurance, white children were 4.2 times as likely (95% CI, 1.7-10.6) as Black children to be using CGM at 1 year. Among those with government insurance, white children were 3.4 times as likely (95% CI, 1.2-9.3) to be using CGM at 1 year.
“We expected to see the largest differences in children starting to use the device,” Hawkes said. “However, we found that non-Hispanic Black children are also much more likely to stop using CGM within the first year.”
The researchers noted that interventions are needed to reduce disparities in CGM use.
“It is important that we are all aware of race disparities in our practice, and make every effort to ensure equity,” Hawke said. “In this study, we have shown that simply prescribing more technology will not solve the problem. We also need to understand and address the barriers to continued use of this technology once it is prescribed.”
For more information:
Colin Hawkes, MD, PhD, can be reached at email@example.com.