Gaps in Access to Diabetes Technology Continue to Grow for Racial Minorities

Robert Vigersky, MD

Despite a growing emphasis in recent years on addressing race-based inequities in care, new research is painting a grim picture regarding access to and adoption of newer diabetes technologies, specifically continuous glucose monitoring and insulin pump use.

Carried out by a trio of investigators from Medtronic, results of the study demonstrate significant racial/ethnic disparities in access among patients with type 1 diabetes are not only persisting but may have worsened in recent years.

“This study highlights the complexity of the causes of health disparities in diabetes. Previous studies in non-Medicare beneficiaries point to socio-economic status as the key driver of unequal adoption of diabetes technology, but our study shows many other contributing factors,” said Robert Vigersky, MD, chief medical officer of Medtronic Diabetes, in a statement from The Endocrine Society. "Other factors include unconscious bias among healthcare providers who may feel that people of color may not be able to use these technologies. In addition, there are cultural barriers, low health literacy and limited access to healthcare, particularly to endocrinologists.”

In light of the American Diabetes Association’s recent push for more equitable access to newer diabetes technology, Vigersky and a pair of colleagues at Medtronic designed the current study with the intent of assessing prevalence of insulin pump and CGM use among Medicare beneficiaries with type 1 diabetes according to racial or ethnic background. Using the Medicare fee-for-service database, the study was designed to leverage data from the Medicare fee-for-service database and assess prevalence of technology use for enrollees from 2017-2019 and to compare users and nonusers based on race/ethnicity, sex, age, Medicare eligibility criteria, and visits to an endocrinologist.

To be included in the study, participants were required to have continuous enrollment in Medicare fee-for-service parts A and B and needed to have at least 1 inpatient or 2 outpatient claims for type 1 diabetes in each calendar year. For the purpose of analysis, racial/ethnic groups were defined as Black, White, and Other.

Upon analysis, investigators discovered that although prevalence of pump use increased from 11-8% to 15.3% from 2017-2019, the differences between racial/ethnic groups were significant for prevalence of pumps, CGM, or any technology use. Investigators pointed out 18.2% of White beneficiaries compared to just 4.6% of Black beneficiaries used pumps in 2019.

When assessing CGM use, results suggested use of CGM increased from 2.6% in 2017 to 12.0% in 2018 and to 22.1% in 2019. However, as with pump use, White beneficiaries were more likely to use CGM, with use rates of 24.9% among White beneficiaries in 2019 compared to 11.8% for Black and 10.2% for Other beneficiaries. For overall technology use, prevalence increased from 12.7% in 2017, to 19.4% in 2018 and to 28% in 2019. In 2019, technology use was reported among 31.9% of White beneficiaries, 14% of Black beneficiaries, and 12.1% of Other beneficiaries (P <.001).

In analyses evaluating absolute percentages of change from 2018 to 2019, results indicated prevalence of pump, CGM, and any technology use were greater among White beneficiaries than for Black or Other beneficiaries. From 2018 to 2019, prevalence of CGM use among White beneficiaries rose 10.8% from 14.1% to 24.9%, but only rose 7.5% among Black beneficiaries from 4.3% to 11.8% and just 5.4% for Other beneficiaries from 4.8% to 10.2%.

“We need to address the social determinants of health, including race and ethnicity, before all aspects of diabetes care become more equitable,” added Vigersky, who is Past President of The Endocrine Society.

This study, “Inequity in Adoption of Advanced Diabetes Technologies Among Medicare Fee-for-Service Beneficiaries,” was published in the Journal of Clinical Endocrinology and Metabolism.