Black Patients Less Likely to be Prescribed, Have Discussions around CGMs, Insulin Pumps

A new analysis of data from medical centers associated with Johns Hopkins Comprehensive Diabetes Center is underlining the existing racial disparities regarding continuous glucose monitoring (CGM) and insulin pumps in adults with type 1 diabetes.

A retrospective analysis of data recorded from April 2013-January 2020, results of the study suggest Black patients with type 1 diabetes were not only less likely to receive a CGM system or insulin pump but also less likely to have their provider engage in discussions around use of newer diabetes technologies in analyses adjusted for social determinants of health and diabetes outcomes.

“Our findings revealed marked racial disparities in diabetes technology discussions, prescribing, and use in adults with [type 1 diabetes]. Further qualitative and well-designed prospective studies incorporating the perspectives of patients are needed to elucidate the causes behind these disparities in order to develop, implement, and evaluate strategies to reduce them,” wrote investigators.

Since the advent of CGM and insulin pumps into treatment algorithms for people with type 1 diabetes, mountains of data have emerged detailing the benefits of these technologies in management of type 1 diabetes. Despite the proven benefits on glycemic control and quality of life, suboptimal uptake reduces the potential population-level impact this technology could provide. With previous data outlining race-based disparities among diabetes technology uptake among children and adolescents with type 1 diabetes, a Johns Hopkins University School of Medicine-led team launched the current study to provide an overview of racial disparities related to diabetes technology among adults with type 1 diabetes receiving care at four diabetes clinics associated with the Johns Hopkins Comprehensive Diabetes Center.

A retrospective analysis focused on those who received care from April 2013-January 2020, investigators designed their analyses to examine baseline and prevalent technology use, rates of diabetes technology discussions, and prescribing of CGM systems and insulin pumps, with race categorized as Black and non-Black. For the purpose of analysis, investigators used multivariable logistic regression analysis to estimate associations of technology prescribing and discussions with patient race, with adjustment for social determinants of health and diabetes outcomes. Investigators noted CGM systems and insulin pumps were assessed separately.

Overall, 1258 patients were identified for inclusion in the current study. This cohort had a median age of 36 (IQR, 26-52) years and a median diabetes duration of 17 (IQR, 7-27) years. Of the 1258 included in the study, 19.2% were Black. Compared to their non-Black counterparts, Black adults with type 1 diabetes had fewer diabetes clinic visits (6 vs 7), more hospitalizations for diabetic ketoacidosis or hyperosmolar hyperglycemic state (10.4% vs 2.4%) and hypoglycemia (9.5% vs 2.0%), higher A1C levels (9.0% vs 7.5% for first HbA1c; 8.7% vs 7.4% for last HbA1c), and higher prevalence of microvascular complications (53.1% vs 36.5%).

Significantly lower baseline technology use was observed for both CGM (7.9% vs 30.3%) and insulin pumps (18.7% vs 49.6%) for Black patients compared with non-Black patients. Analysis of prevalent use revealed a similar trend, with CGM use observed among 43.6% of Black patients and 72.1% of non-Black patients and insulin pump use observed among 30.7% of Black patients and 64.2% of non-Black patients. When assessing CGM specifically, results indicated Black patients were 49% (aOR, 0.51 [95% CI, 0.29-0.90]) less likely to have a discussion around CGM with a provider and 39% (aOR, 0.51 [95% CI, 0.29-0.90]) less likely to receive a prescription for a CGM system. When assessing insulin pumps specifically, results indicated Black patients were 26% (aOR, 0.74 [95% CI, 0.44-1.25]) less likely to have a discussion around insulin pump use and 60% (aOR, 0.40 [95% CI, 0.22-0.70]) less likely to receive a prescription for an insulin pump.

“Prospective studies should assess the impact of provider type, training, and experience, racial concordance of provider and patient, quantity/quality of provider-patient discussions, patient sustained use of technologies, and ethnic disparities on technology use,” investigators concluded.

This study, “Racial Disparities in Access and Use of Diabetes Technology Among Adult Patients With Type 1 Diabetes in a U.S. Academic Medical Center,” was published in Diabetes Care.