“I Didn't Really Have a Choice”: Qualitative Analysis of Racial-Ethnic Disparities in Diabetes Technology Use Among Young Adults with Type 1 Diabetes

Agarwal, Shivani; Crespo-Ramos, Gladys; Long, Judith A.; Miller, Victoria A.

doi:10.1089/dia.2021.0075

Cited by 46 publications

(35 citation statements)

References 37 publications

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“…7,10,74 Therefore, in addition to increased access to sophisticated insulin delivery and glucose sensor systems, patients and their families should also receive enhanced support necessary to overcome special barriers to management and assist with long-term acceptance and utilization. 75,76 Frequent contact with the family in their home could be accomplished with video conferencing apps. 75,77-79 Video conferencing use was infrequent in pediatric diabetology but quickly burgeoned during the COVID-19 emergency in the spring of 2020 and has become more widely used and accepted by patients and practitioners.…”

Section: Can Technology Be Used To Overcome Racial Disparity In Hba1c Outcomes?mentioning

confidence: 99%

Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes?

Chalew

Delamater

Washington

et al. 2021

J Diabetes Sci Technol

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Achieving normal or near-normal glycemic control as reflected by HbA1c levels in patients with type 1 diabetes (T1D) is important for preventing the development and progression of chronic complications. Despite delineation and dissemination of HbA1c management targets and advances in insulin pharmacology, insulin delivery systems, and glucose monitoring, the majority of children with T1D do not achieve HbA1c goals. In particular, African Americans are more likely not to reach HbA1c goals and have persistently higher HbA1c than Non-Hispanic Whites. Availability of pumps and other technology has not eliminated the disparity in HbA1c. Multiple factors play a role in the persisting racial disparity in HbA1c outcome. The carefully designed application and deployment of new technology to help the patient/family and facilitate the supportive role of the diabetes management team may be able to overcome racial disparity in glycemic outcome and improve patient quality of life.

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Section: Can Technology Be Used To Overcome Racial Disparity In Hba1c Outcomes?mentioning

confidence: 99%

Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes?

Chalew

Delamater

Washington

et al. 2021

J Diabetes Sci Technol

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“…CGM use has quadrupled over the past decade due to its heavy clinical endorsement, but its adoption has lagged behind in non-white populations. 36 Finally, only one motivation enhancement therapist was utilized, who also happened to be the principal investigator; which may have limited the generalizability of our findings and generated some bias by participants to give favorable reviews.…”

Section: Limitationsmentioning

confidence: 99%

Personalized Big Data for Type 1 Diabetes Exercise Support

Ash¹,

Nally²,

Stults‐Kolehmainen³

et al. 2021

Preprint

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Objective: Evaluate feasibility, safety, acceptability, and estimate efficacy of an exercise promotion intervention for adults with type 1 diabetes (T1D) and sub-optimal baseline exercise patterns.Design: Single-group, 2-week baseline observation then 10-week intervention with follow-up observation.Setting: Community-based sample participating remotely with physician oversightParticipants: Volunteers 18-65 years old with T1D screened for medical readiness for exercise intervention offerings. N=20 enrolled, N=17 completing all outcomes with 88%-91% biosensor adherence. Intervention: Feedback on big data from continuous glucose monitoring (CGM), its intersection with other ecological datasets (exercise, mood, sleep), and other informational and motivational elements (exercise videos, text-based exercise coach, self-monitoring diary). Main Outcome Measures: Feasibility (use metrics, assessment completion), safety (mild and severe hypoglycemia, diabetic ketoacidosis), acceptability (system usability scale, single items, interview themes), standard clinical and psychosocial assessments.Results: Participants increased exercise from a median of 4 (IQR 0, 41) to 64 (20, 129) minutes per week (p=.004, d=0.71) with no severe hypoglycemia or ketoacidosis. Body mass index increased (29.5±5.1 to 29.8±5.4 kg/m2, p= .02, d= 0.57). Highest satisfaction ratings were for CGM use (89%) and data on exercise and its intersection with CGM and sleep (94%). Satisfaction was primarily due to improved exercise management behavioral skills, although derived motivation was transient.Conclusions: The use of personalized big data from biosensors to substantiate human-delivered, client-centered exercise support for T1D is feasible and acceptable for interventions involving big data collection. However, there is a need for more intensive, sustained support. The big data could support informatics-based, automated motivational tools.

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“…However, underserved populations have to manage an array of challenges that are unique and unaccounted for in traditional healthcare paradigms. Low health literacy, limited proficiency with English, difficulty accessing appointments with primary care providers/endocrinologists, racism, and the burdens of economic hardship are highly prevalent and pose as serious barriers to self-management of diabetes [ 8 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, recent studies demonstrate wide disparities in diabetes technology use across the lifespan for CGM, insulin pump therapy, data management platforms, and telehealth, which reduces their true potential. [ 9 , 10 , 15 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

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

Agarwal

Simmonds²,

Myers

2022

Curr Diab Rep

Self Cite

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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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“I Didn't Really Have a Choice”: Qualitative Analysis of Racial-Ethnic Disparities in Diabetes Technology Use Among Young Adults with Type 1 Diabetes

Cited by 46 publications

References 37 publications

Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes?

Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes?

Personalized Big Data for Type 1 Diabetes Exercise Support

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

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