These preliminary results support the growing literature that finds that exercise may improve cognition among older adult with DM. Additional research is needed to clarify why certain aspects of executive function might be differentially affected. The current findings may encourage physicians to prescribe exercise for diabetes management and may help motivate DM patients' compliance for engaging in physical activity.
Disparities in type 1 diabetes related to use of technologies like continuous glucose monitors (CGMs) and utilization of diabetes care are pronounced based on socioeconomic status (SES), race, and ethnicity. However, systematic reports of perspectives from patients in vulnerable communities regarding barriers are limited.
RESEARCH DESIGN AND METHODSTo better understand barriers, focus groups were conducted in Florida and California with adults $18 years old with type 1 diabetes with selection criteria including hospitalization for diabetic ketoacidosis, HbA 1c >9%, and/or receiving care at a Federally Qualified Health Center. Sixteen focus groups were conducted in English or Spanish with 86 adults (mean age 42 ± 16.2 years). Transcript themes and pre-focus group demographic survey data were analyzed. In order of frequency, barriers to diabetes technology and endocrinology care included: 1) provider level (negative provider encounters); 2) system level (financial coverage); and 3) individual level (preferences).
RESULTSOver 50% of participants had not seen an endocrinologist in the past year or were only seen once including during hospital visits. In Florida, there was less technology use overall (38% used CGMs in FL and 63% in CA; 43% used pumps in FL and 69% in CA) and significant differences in pump use by SES (P 5 0.02 in FL; P 5 0.08 in CA) and race/ethnicity (P 5 0.01 in FL; P 5 0.80 in CA). In California, there were significant differences in CGM use by race/ethnicity (P 5 0.05 in CA; P 5 0.56 in FL) and education level (P 5 0.02 in CA; P 5 0.90 in FL).
CONCLUSIONSThese findings provide novel insights into the experiences of vulnerable communities and demonstrate the need for multilevel interventions aimed at offsetting disparities in diabetes.Health outcomes in type 1 diabetes in the U.S. are profoundly shaped by socioeconomic status (SES), race, and ethnicity from childhood and throughout the life span. People living with type 1 diabetes from low SES households face elevated risks for suboptimal glycemic control, diabetic ketoacidosis (DKA), disease
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