Research Highlights Racial Disparities in Use of Diabetes Technology

Kamonkiat Wirunsawanya, MD

African American and Hispanic patients used diabetes technology significantly less than Caucasian patients, according to the findings of new research to be presented at the Endocrine Society (ENDO) 2020 Annual Scientific Sessions.

In a review of more than 200 patients with type 1 diabetes, Kamonkiat Wirunsawanya, MD, and colleagues from Boston University Medical Center examined racial differences in the use of continuous glucose monitors and continuous subcutaneous insulin infusion technologies. The team found that the use of the technologies in the Caucasian group was statistically significantly higher than in non-Caucasian groups except for the Asian group.

The findings highlighted the need to address the barriers to accessing diabetes technology for non-Caucasian individuals to decrease health disparities.

Lead author Wirunsawanya, a fellow at Boston University, and the team of investigators reviewed 227 patients >18 years old with type 1 diabetes who were seen at the Endocrinology clinic at a safety-net hospital between October 2016-September 2017. The investigators used statistical analysis to assess the likelihood of the use of diabetes technology across different races.

Among the patients included, the mean age was 39 years old, 59% were male, and the mean duration of diabetes was 21 years. Some patients were overweight (30%), while 22% had obesity. Half of those analyzed had government insurance and 80% spoke English.

For race/ethnicity, 43% of the patients were Caucasian; 25% were African American; 15% were Hispanic, 15% were defined as “other”; and 2% were Asian.

The mean HbA1c±standard deviation of any technology and non-technology users were 8.27±1.58 and 9.49±2.04. Those who had government health insurance had lower odds of using technology (OR, .43; 95% CI, .25-.74) than patients with private health insurance.

Slightly more than 25% of patients used continuous subcutaneous insulin infusion—43% of that population were Caucasian, 14% African American, and 14.2% Hispanic.

In a model adjusted for insurance and language, African American and those categorized as “other” had statistically lower odds of using technology (African American: OR, .25; 95% CI, .11-.53; Other: OR, .33; 95% CI, .12-.89) compared to patients in the Caucasian group.

Continuous glucose monitor and continuous subcutaneous insulin infusion devices have been shown to improve outcomes in patients with type 1 diabetes. But minority patients face barriers, prohibiting them from using the beneficial technologies.

“We hope our findings will allow endocrinologists to design and implement effective strategies to increase the use of technology among minority patients with type 1 diabetes,” Wirunsawanya said in a statement.

Future exploration of barriers could help minority patients have better access to the technology.

The study, “Racial Differences in Technology Use Among Type 1 Diabetes in a Safety-Net Hospital,” will be presented at the Endocrine Society (ENDO) 2020 Annual Scientific Sessions.