Black young adults with type 1 diabetes less likely to use CGM, insulin pump
Insulin pump and continuous glucose monitor use were lower among Black young adults with type 1 diabetes in the U.S. compared with their white and Hispanic peers after adjusting for socioeconomic status, according to study data.
“Our findings demonstrate several key points: Socioeconomic status is not the main driver of racial-ethnic disparities in diabetes technology use as hypothesized previously, although we found a measurable effect,” Shivani Agarwal, MD, MPH, director of the Supporting Emerging Adults with Diabetes Program at Montefiore and an assistant professor of medicine at Albert Einstein College of Medicine in New York, and colleagues wrote in a study published in Diabetes Technology & Therapeutics. “There are differences in disparity patterns between non-Hispanic Black and Hispanic young adults, with much worse disparities among non-Hispanic Black young adults. Other factors that may be related to socioeconomic position, such as clinic attendance and self-management, are not independently predictive of disparities in technology use.”
Researchers recruited 300 adults aged 18 to 25 years who had type 1 diabetes for at least 6 months and were able to read English (mean age, 20 years, 55% women). All participants were selected from six type 1 diabetes exchange clinic network sites in different urban regions in the United States. The study population included 100 non-Hispanic white adults, 97 non-Hispanic Black adults and 103 Hispanic adults. Participants completed a survey and provided information on personal income, marital status, employment status, education, health literacy, health clinic attendance, health care setting, self-monitoring of blood glucose and diabetes self-care. Researchers extracted data on insulin pump and CGM use from each participant’s medical charts from the year prior to study enrollment.
A significantly higher proportion of white participants used an insulin pump (72%) compared with Hispanic (39%) and Black individuals (18%). The numbers were similar with CGM use, with the white group (71%) having a higher percentage of users than the Hispanic (37%) and Black cohorts (28%).
Researchers adjusted insulin pump and CGM use for socioeconomic status, demographics, study site, health care factors and diabetes self-management. In the adjusted data, a significant difference remained between white participants and Black individuals in insulin pump use (61% vs. 20%, respectively) and CGM use (53% vs. 31%, respectively). The difference between the white and Black cohorts was larger than the gap between the white and Hispanic groups. In the adjusted data, Hispanic insulin pump use increased to 49% and CGM use to 58%.
“There are large disparities in insulin pump and CGM use among non-Hispanic Black and Hispanic young adults with type 1 diabetes compared with non-Hispanic white young adults, which were not fully explained by socioeconomic status, demographics, health care factors or diabetes self-management,” the researchers wrote. “Disparities were largest between non-Hispanic Black and white young adults, even after adjustment for multiple factors.”
Researchers said future studies should examine preferences for patients from historically underrepresented groups, health care provider implicit bias, mistrust of medical systems and patient-provider relationships to assess whether these factors contribute to insulin pump and CGM use disparities.
“As the pace of innovation in diabetes technology accelerates and raises standards of care in type 1 diabetes, understanding and eliminating disparities in use of these important new therapeutics is crucial to overcoming and disrupting the cycle of inequity in long-term outcomes for minority type 1 diabetes populations,” the researchers wrote.