Recent studies demonstrate wide racial/ethnic disparity in insulin pump and continuous glucose monitor (CGM) use in people with T1D. It remains unknown whether socioeconomic status (SES) or other factors drive disparities. We recruited 300 diverse YA with T1D from 6 diabetes centers across the U.S. (ages 18-28; 33% non-Hispanic White, 32% non-Hispanic Black, 34% Hispanic; 52% public/no insurance; median A1c 9.2%). We used logistic regression to examine how patient-reported and chart-extracted variables, including multiple socioeconomic and individual-level factors, accounted for racial/ethnic disparity in current pump or ever CGM use. Compared with White YA (71/72%), both Black (18/28%) and Hispanic (37/39%) YA had significantly lower pump and CGM use, respectively (p<0.001). Pump and CGM users were more likely to have lower A1c levels, higher attained education, greater household income, lower neighborhood poverty, private insurance, higher diabetes numeracy and literacy, and receive care in a pediatric or combined pediatric-adult center (p<0.001). They were also more likely to report frequent self-monitoring of blood glucose and diabetes medical visit attendance (p<0.001). Full adjustment for these multiple SES, self-management, and care factors did little to explain racial/ethnic disparity. Compared with White YA, Black and Hispanic YA had persistent 50-80% lower odds of insulin pump use and Black YA had 70% lower odds of CGM use (OR (95% CI) Pump: Black 0.125 (0.050, 0.313), Hispanic 0.427 (0.176, 1.035); CGM: Black 0.291 (0.121, 0.702)). In contrast, these variables accounted for more of the CGM disparity between White and Hispanic YA (OR (95% CI) 1.007 (0.409, 2.483)). Exploration of factors other than SES and self-management is needed to examine disparity in diabetes technology use, especially in Black YA. Black and Hispanic YA preferences for technology and provider factors should be considered.
S. Agarwal: None. C. Schechter: None. J.S. Gonzalez: None. J.A. Long: None.
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896)