Early racial/ethnic disparities in continuous glucose monitor use in pediatric type 1 diabetes

Lai, Charlene W.; Lipman, Terri H.; Willi, Steven M.; Hawkes, Colin P.

doi:10.1089/dia.2021.0120

Cited by 10 publications

(8 citation statements)

References 24 publications

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“…The recent exponential increase in continuous glucose monitor (CGM) adoption for those with type 1 diabetes has come with widening disparities between the least and most socially privileged ( 1 – 6 ). There is currently much interest in expanding access to CGM for patients with type 2 diabetes not at glycemic target to help achieve better HbA 1c , lower glycemic variability and hypoglycemic events, and increased time in range ( 7 – 9 ).…”

Section: Introductionmentioning

confidence: 99%

Effect of CGM Access Expansion on Uptake Among Patients on Medicaid With Diabetes

Tampe

Sol

et al. 2022

Diabetes Care

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OBJECTIVE Current studies on continuous glucose monitor (CGM) uptake are revealing for significant barriers and inequities for CGM use among patients from socially underprivileged communities. This study explores the effect of full subsidies regardless of diabetes type on CGM uptake and HbA1c outcomes in a U.S. adult patient population on Medicaid. RESEARCH DESIGN AND METHODS This retrospective cohort study examined 3,036 adults with diabetes enrolled in a U.S. Medicaid program that fully subsidized CGM. CGM uptake and adherence were assessed by CGM prescription and dispense data, including more than one fill and adherence by medication possession ratio (MPR). Multivariate logistic regression evaluated predictors of CGM uptake. Pre- and post-CGM use HbA1c were compared. RESULTS CGM were very well received by both individuals with type 1 diabetes and individuals with type 2 diabetes with similar high fill adherence levels (mean MPR 0.78 vs. 0.72; P = 0.06). No significant difference in CGM uptake outcomes were noted among major racial/ethnic groups. CGM use was associated with improved HbA1c among those with type 2 diabetes (−1.2% [13.1 mmol/mol]; P < 0.001) that was comparable between major racial/ethnic groups and those with higher fill adherence achieved greater HbA1c reduction (−1.4% [15.3 mmol/mol]; P < 0.001) compared with those with lower adherence (−1.0% [10.9 mmol/mol]; P < 0.001). CONCLUSIONS CGM uptake disparities can largely be overcome by eliminating CGM cost barriers. CGM use was associated with improved HbA1c across all major racial/ethnic groups, highlighting broad CGM appeal, utilization, and effectiveness across an underprivileged patient population.

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Section: Introductionmentioning

confidence: 99%

Effect of CGM Access Expansion on Uptake Among Patients on Medicaid With Diabetes

Tampe

Sol

et al. 2022

Diabetes Care

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“…3,15,16 Several studies have demonstrated that disparity in technology use remains even after controlling for household income and insurance status. 4,13,17,18 Similarly, rates of CGM use in NHB compared to NHW is significantly lower, regardless of government or commercial insurance. 19 This racial disparity in use of insulin pumps and CGMs emerges early in T1D care and has been demonstrated within the first year following diagnosis of T1D.…”

mentioning

confidence: 99%

“…19 This racial disparity in use of insulin pumps and CGMs emerges early in T1D care and has been demonstrated within the first year following diagnosis of T1D. 17 As novel diabetes technologies have continued to emerge, they have appeared to widen disparities. For example, Lipman et al 18 reported that NHW were 2 times more likely in 2005 and 2.5 times more likely in 2019 to use an insulin pump compared to NHB youth, revealing a widening disparity over time.…”

mentioning

confidence: 99%

“…Increasing phase 1 research has been conducted to detect and measure health disparities in T1D health outcomes and technology use in youth. 4,17 Recent phase 2 disparities research has focused on understanding the potential determinants of diabetes technology disparities. For example, Mencher et al, 23 in a qualitative study exploring factors that influenced decision making, reported that NHB adolescents and parents made decisions to not use diabetes technology because of worries of stigmatization and mistrust of the medical community.…”

mentioning

confidence: 99%

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Racial Disparities in Technology Use in Children With Type 1 Diabetes: A Qualitative Content Analysis of Parents’ Perspectives

Howe

Morone

Hawkes

et al. 2023

The Science of Diabetes Self-Management and Care

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Purpose: The purpose of the study was to describe differences in non-Hispanic Black (NHB) and non-Hispanic White (NHW) parents’ perceptions of factors that influence the use of diabetes technology. Methods: Focus groups were conducted with parents of NHB and NHW children at a pediatric diabetes center in the Northeast United States. Kilbourne’s health disparities framework informed the focus group guide and a priori coding for directed content analysis. Further analysis allowed subcategories to emerge inductively. Results: Twenty-one parents participated. Five subcategories emerged, describing differences in NHB and NHW parent decisions regarding diabetes technology: (1) child’s choice, (2) shame versus pride, (3) pros and cons of technology, (4) time frame, and (5) blood glucose indications of readiness. NHB parents feared technology malfunction, worried that visible devices could worsen experienced stigma of diabetes diagnosis, and described the diabetes team as gatekeepers, who changed eligibility criteria for diabetes technology use for their research purposes. In contrast, NHW parents reported diabetes team expectation of diabetes technology use and did not report provider-related barriers. Conclusion: This study adds to existing literature advancing our understanding of the patient and provider mechanisms underlying racial disparities in diabetes technology use. This understanding may guide development of interventions focused on patients, providers, and structural factors to improve equity in use of diabetes technology by youth with type 1 diabetes.

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“…A study in the USA showed that publicly insured paediatric patients with T1D successfully utilized CGM and experienced benefits similar to those previously demonstrated in a predominantly privately insured paediatric population [48 ▪ ]. Another major paediatric diabetes centre in the USA recently reported that even when insurance coverage is not a barrier to access, CGM is initiated more frequently in non-Hispanic white children than in non-Hispanic black and Hispanic children [49 ▪▪ ,50]. Moreover, in those who started CGM, non-Hispanic black children were more likely than non-Hispanic white and Hispanic children to discontinue its use within the first year.…”

Section: Continuous Glucose Monitoringmentioning

confidence: 65%

Monitoring of paediatric type 1 diabetes

Marks

Wolfsdorf

2022

Current Opinion in Pediatrics

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Purpose of reviewThis article reviews recent developments in methods used to monitor paediatric type 1 diabetes (T1D), including an examination of the role of glycated haemoglobin (haemoglobin A1c) and its limitations for long-term assessment of glycaemia in individual patients, self-monitoring of blood glucose, continuous glucose monitoring (CGM) systems and ketone monitoring. Recent findingsMonitoring of glycemia and ketones, when indicated, is a cornerstone of paediatric T1D management and is essential to optimize glycaemic control. Ongoing technological advancements have led to rapid changes and considerable improvement in the methods used to monitor glucose concentrations in people with T1D. As a result of recent innovations that have enhanced accuracy and usability, CGM is now considered the optimal method for monitoring glucose concentrations and should be introduced soon after diagnosis of T1D. SummaryPatients/families and healthcare providers must receive comprehensive education and proper training in the use of CGM and interpretation of the vast amounts of data. Future challenges include ensuring equal access to and optimizing clinical use of CGM to further improve T1D care and outcomes.

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Early racial/ethnic disparities in continuous glucose monitor use in pediatric type 1 diabetes

Cited by 10 publications

References 24 publications

Effect of CGM Access Expansion on Uptake Among Patients on Medicaid With Diabetes

Effect of CGM Access Expansion on Uptake Among Patients on Medicaid With Diabetes

Racial Disparities in Technology Use in Children With Type 1 Diabetes: A Qualitative Content Analysis of Parents’ Perspectives

Monitoring of paediatric type 1 diabetes

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