Racial-Ethnic Disparities in Diabetes Technology Use Among Young Adults with Type 1 Diabetes.

BACKGROUND: Recent studies highlight racial-ethnic disparities in insulin pump and continuous glucose monitor (CGM) use in people with type 1 diabetes (T1D), but drivers of disparities remain poorly understood beyond socioeconomic status (SES).

METHODS: We recruited a diverse sample of young adults (YA) with T1D from six diabetes centers across the U.S., enrolling equal numbers of Non-Hispanic (NH) White, NH Black, and Hispanic YA. We used multivariate logistic regression to examine to what extent SES, demographics, healthcare factors (care setting, clinic attendance) and diabetes self-management (diabetes numeracy, self-monitoring of blood glucose, and self-care inventory score) explained insulin pump and CGM use in each racial-ethnic group.

RESULTS: We recruited 300 YA with T1D, ages 18-28 years. Fifty-two percent were publicly insured and median HbA1c was 9.2%. Large racial-ethnic disparities in pump and CGM use existed: 72% and 71% for NH White, 40% and 37% for Hispanic, and 18% and 28% for NH Black, respectively. After adjustment for multiple factors, pump and CGM use remained disparate: 61% and 53% for NH White, 49% and 58% for Hispanic, and 20 and 31% for NH Black, respectively.

CONCLUSIONS: Insulin pump and CGM use was the lowest in NH Black, intermediate in Hispanic, and highest in NH White YA with T1D. Socioeconomic status was not the sole driver of disparities nor did additional demographic, healthcare, or diabetes-specific factors fully explain disparities, especially between NH Black and White YA. Future work should examine how minority YA preferences, provider implicit bias, systemic racism, and mistrust of medical systems, help to explain disparities in diabetes technology use.