Black children less likely to start, continue CGM after type 1 diabetes diagnosis
Non-Hispanic Black children are less likely to start continuous glucose monitoring within 1 year of diabetes diagnosis compared with non-Hispanic white children, according to study data.
“We have shown that racial-ethnic disparities in CGM use begins within the first year after diagnosis of type 1 diabetes,” Colin P. Hawkes, MD, PhD, attending physician in the division of endocrinology and diabetes and clinical director of the Diabetes Center at Children’s Hospital of Philadelphia, and colleagues wrote in a study published in Diabetes Technology & Therapeutics. “CGM initiation was lowest among non-Hispanic Black children, intermediate in Hispanic children and highest in non-Hispanic white children. Ongoing use of CGM at 1-year post-initiation was higher among non-Hispanic white children when compared with non-Hispanic Black children.”
Researchers conducted a retrospective chart review of children with type 1 diabetes diagnosed between January 2016 and April 1, 2018, and followed at Children’s Hospital of Philadelphia. Children who self-identified as non-Hispanic white, non-Hispanic Black or Hispanic were included in the study. Primary insurance was used as a surrogate for socioeconomic status, with government insurance defined as a lower socioeconomic status. Children were identified as having started CGM if they began use of a Dexcom or Medtronic CGM device. Age, sex, race and ethnicity, diabetes type, date of birth, date of diagnosis, date of CGM initiation and insurance type were extracted from electronic health records.
There were 345 children included in the study (43% girls) of whom 238 were white children, 54 were non-Hispanic Black children and 29 were Hispanic children. A lower percentage of white children (19%) had government insurance compared with Black children (61%) and Hispanic children (72%; P < .001 for both).
Disparities in CGM initiation
Within the first year of diagnosis, 158 participants started using CGM, including 133 white children, 15 Black children and 10 Hispanic children. More children with commercial insurance started using CGM compared with government insurance (54% vs. 27%; P < .001).
A higher proportion of white children began CGM within 1 year of diagnosis compared with Black children (51% vs. 28%; P = .006). There was an intermediate difference between white and Hispanic children in CGM initiation (51% vs. 35%; P = .3). White children were more than two times more likely to start CGM compared with Black children (OR = 2.6; 95% CI, 1.4-5.1) and twice as likely to start CGM compared with Hispanic children (OR = 2; 95% CI, 0.9-4.4).
For those with commercial insurance, 56% of white children started CGM within 1 year of diagnosis compared with 29% of Black children (P = .045). White children with commercial insurance were more than three times more likely to initiate CGM within a year of diabetes diagnosis compared with Black children with commercial insurance (OR = 3.3; 95% CI, 1.2-8.6). For children with government insurance, similar rates of CGM initiation were observed in all three racial-ethnic groups.
“The etiology of these disparities is not well understood,” the researchers wrote. “The first year of learning to manage type 1 diabetes is challenging and has been associated with high rates of anxiety and depression among families. This provides an additional challenge for families with unaddressed difficulties related to social determinants of health, including health literacy, food security, safe housing and a supportive social network.”
Black children less likely to continue CGM
Of participants who started CGM, 94% continued using the device 1 year after initiation. Black children were less likely to continue CGM after 1 year compared with white children (73% vs. 96%; P = .003). For those with commercial insurance, fewer Black children continued use of CGM after 1 year compared with white children (67% vs. 97%; P = .003).
“Racial disparities in diabetes care emerge early and persist throughout the management of this chronic disease,” the researchers wrote. “In order to advance beyond merely documenting disparities and move towards health equity, we must understand the etiology of these inequities. Social determinants of health, including structural racism, are likely playing a role in disparities in the care and outcomes of children with type 1 diabetes.”