Previous research has documented racial/ethnic disparity in continuous glucose monitor and insulin pump use in people with T1D. It remains unknown whether disparities result from socioeconomic status or other factors. We recruited 17 YA with T1D from an underserved area (mean age 22, 5 non-Hispanic Black, 12 Hispanic, 88% Medicaid, duration 11 yrs, median HbA1c 9.6%) and conducted semi-structured individual interviews in English or Spanish. We asked questions about how YA were introduced to diabetes technology and what helped them make decisions for use. We developed a standard codebook to direct content analysis and achieved thematic saturation. Our results revealed 3 main themes surrounding information and decisions on technology use: 1) providers were the gateway for information and access; 2) patients were not typically included in decision-making, but were more likely to accept use when they were; and 3) cost was not an issue. Half of participants reported they were never offered or told about diabetes technology in the past despite long diabetes duration. For those with whom technology was discussed, most stated they were not included in the decision process to receive such technology. Some participants reported that providers refused prescription of technology due to lack of demonstration of self-management skills. Still, no alternative options or goal-setting to obtain technology were offered. Some participants desired to learn more about technology but refused to ever start because of perceived extra burden, skepticism of new equipment, or attachment concerns. Very few participants stated they could not afford the technology. Our results suggest that racial/ethnic disparity in technology use may originate at the patient-provider level. Deeper examination of implicit bias in prescribing practices is needed, as well as understanding of minority YA preferences and promotion of shared decision-making.
G. Crespo-Ramos: None. V. Miller: None. J.S. Gonzalez: None. A. Jang: None. S. Agarwal: None.
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896)