Disparities in diabetes technology utilization in youth with diabetes.

Abstract

BackgroundDiabetes technology can improve glycemic variability and diabetes outcomes, but there are disparities in patient use.AimsIdentify racial, ethnic, and socioeconomic disparities in technology utilization and determine provider-, patient-, and parent-identified barriers.MethodsTechnology (continuous glucose monitors (CGM) and pump) usage and demographic data on patients at a large urban pediatric hospital were obtained from a clinical database. Providers (16 attending physicians, five fellow physicians, five nurse practitioners, 13 diabetes educators) completed a survey on diabetes technology prescribing habits. English and Spanish-speaking patients ages 8 to 17 years with diabetes (n=109) and caregivers of pediatric patients with diabetes (n=117) completed surveys that assessed attitudes and perceived benefits/burdens of diabetes technology.ResultsFrom August 2020 to 2021, independent of insurance payor status, non-Hispanic Black (NHB) and Hispanic youth with type 1 diabetes were less likely to use pump therapy (OR 0.4 and 0.35, respectively) or CGM (OR 0.74 and 0.54) compared with non-Hispanic White (NHW) youth. For pump eligibility, diabetes educators placed higher importance on subjective factors such as parental education, health literacy, and psychosocial stability (p value <0.05) compared with physicians. Hispanic and NHB patients and parents learned about diabetes technology later after diabetes diagnosis compared with NHW patients/caregivers. Physicians and diabetes educators, but not patients themselves, identified patient-perceived barriers to CGM use (ie, embarrassment and/or discomfort in wearing devices) as reasons for not utilizing diabetes technology.ConclusionsThere are marked disparities in diabetes technology use among youth with diabetes. Findings from the provider surveys showed reliance on subjective variables as opposed to objective criteria. Youth with diabetes and caregivers of underrepresented race/ethnicities learned about diabetes technology later and were less likely to use technology. Though clinic providers perceived multiple barriers to technology utilization, responses from families showed low perceived burden and highly positive attitudes.