How organizations shape medical technology allocation: Insulin pumps and pediatric patients with type 1 diabetes

Puckett, Cassidy; Wong, Jenise C.; Daley, Tanicia; Cossen, Kristina

doi:10.1016/j.socscimed.2020.112825

Cited by 12 publications

(14 citation statements)

References 51 publications

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“…In this study, NHB parents' concerns related to pump malfunction supported previous data reporting NHB fear and distrust of insulin pumps and the medical community in general. 30 Although the same information about diabetes technology may have been provided to all parents and children, it may have been delivered in different ways, with different emphasis, or perceived in different ways, as is suggested by the differences in NHB and NHW parental perceptions reflected in this study. The reports from parents in this study suggest that diabetes teams need to increase their awareness of how they frame the use of insulin pumps as either dangerous or safe and whether messages are delivered in different ways due to unconscious racial bias.…”

Section: Discussionmentioning

confidence: 93%

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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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Section: Discussionmentioning

confidence: 93%

“…In this study, NHB parents’ concerns related to pump malfunction supported previous data reporting NHB fear and distrust of insulin pumps and the medical community in general. 30…”

Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…34,36 Institutional eligibility and allocation of diabetes technologies may be impacted by patient interaction, framing of medical technologies to patients, and how clinics structure decision-making processes. 37 Given our findings, these processes, including clinician decision making regarding the use of diabetes technology, the role of communication regarding diabetes technology with patients, and the barriers patients face after prescription of diabetes technology should be evaluated.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Diabetes Technology Use and Outcomes in Type 1 Diabetes in a Safety-Net Hospital

Fantasia

Wirunsawanya

Lee

et al. 2021

J Diabetes Sci Technol

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Background: Limited data exist regarding diabetes technology use among adults with type 1 diabetes (T1D) in urban racially/ethnically diverse safety-net hospitals. We examined racial/ethnic differences in the use of continuous glucose monitor (CGM) and continuous subcutaneous insulin infusion (CSII) in this setting. Methods: A retrospective review of 227 patients ≥ 18 years of age with T1D seen in an urban, safety-net endocrinology clinic during 2016-2017 was completed (mean age: 39; 80% English-speaking; 50% had public insurance). Diabetes technology use, defined as either CGM or CSII or both CGM and CSII, and clinical outcomes were examined by race/ethnicity. Results: Overall, 30% used CGM and 26% used CSII. After adjusting for age, language, insurance, and annual income, diabetes technology use in non-White patients was significantly lower than in White patients, predominantly lower in Black (aOR 0.25 [95% CI 0.11-0.56]) and patients identified as other race/ethnicity (aOR 0.30 [95% CI 0.11-0.77]). At the highest household income level (≥$75,000/y), Black and Hispanic individuals were significantly less likely than White individuals to use diabetes technology ( P < .0007). Mean hemoglobin A1c (HbA1c) was lower in patients using any diabetes technology compared with patients using no technology ( P < .0001). Use of CGM and CSII together was associated with the lowest HbA1c across all racial/ethnic groups. Conclusions: Racial/ethnic disparities in diabetes technology use and glycemic control were observed even after adjusting for sociodemographic factors. Further research should explore barriers to accessing diabetes technology in non-White populations.

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“…Reasons for lack of pump use vary and may include providers not offering pumps, providers stating blood sugars were too high to qualify, preference for MDI, and/or denial due to restrictive insurance eligibility requirements [ 3 ]. A study by Puckett et al found that how providers screened for eligibility and educated children and parents with T1D for an insulin pump greatly influenced use: when pumps were discussed early within the first visit upon meeting patients compared to 6–12 months past the first visit, patients were more likely to agree to and adopt insulin pump [ 32 ]. It is important to note that the ADA does not recommend or require eligible patients to wait for any given period of time for pump allocation.…”

Section: Insulin Pump Therapymentioning

confidence: 99%

The Use of Diabetes Technology to Address Inequity in Health Outcomes: Limitations and Opportunities

Agarwal

Simmonds²,

Myers

2022

Curr Diab Rep

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Purpose of Review The management of diabetes has been revolutionized by the introduction of novel technological treatments and modalities of care, such as continuous glucose monitoring, insulin pump therapy, and telehealth. While these technologies have demonstrated improvement in health outcomes, it remains unclear whether they have reduced inequities from racial/ethnic minority or socioeconomic status. We review the current literature to discuss evidence of benefit, current limitations, and future opportunities of diabetes technologies. Findings While there is ample evidence of the health and psychological benefit of diabetes technologies in large populations of people with type 1 and type 2 diabetes, there remain wide disparities in the use of diabetes technologies, which may be perpetuating or widening inequities. Multilevel barriers include inequitable prescribing practices, lack of support for social determinants of health, mismatch of patient preferences and care models, and cost. Summary We provide a review of disparities in diabetes technology use, possible root causes of continued inequity in outcomes, and insight into ways to overcome remaining gaps.

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How organizations shape medical technology allocation: Insulin pumps and pediatric patients with type 1 diabetes

Cited by 12 publications

References 51 publications

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

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

Racial Disparities in Diabetes Technology Use and Outcomes in Type 1 Diabetes in a Safety-Net Hospital

The Use of Diabetes Technology to Address Inequity in Health Outcomes: Limitations and Opportunities

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