Background: African-American (AA) youth with T1D consistently have higher A1c than White (W) patients, even when using open-loop insulin pumps. AHCL technology utilizes glucose sensor data to guide automatic adjustments of insulin by the pump to mitigate hyper and hypoglycemia. Potentially AHCL could reduce or eliminate disparity in glycemic outcome.
Methods and Results: We performed a chart review of patients using Tandem Control IQ. trained in its use by the manufacturer’s rep and then followed routinely in clinic (n=62) . 9 patients self identified as AA, A1c=9.2%±1; 37 identified as W, A1c=8.23%±1.5. 6 AA patients and 27 W had used AHCL > 60 days and had follow up data. There was statistical and clinically significant reduction in A1c (-1.0%±1.4, p=0.0016) for W patients but not AA. AA patients had higher A1c and sMBG with lower TIU during AHCL use than W patients. (See table below) .
Conclusions: Clinically significant disparity in glycemic outcome persists between AA and W youth during real world use of AHCL. Although this initial report has a relatively small number of participants, the glycemic disparity is consistent with many prior studies using older insulin delivery methods. We conclude that AHCL technology by itself may not be sufficient to overcome racial disparity in glycemic outcome. Additional innovations and support may be required for high-risk patients.
N.J.Christakis: None. S.Chalew: Advisory Panel; Medtronic.
National Institutes of Health (U54GM1O4940) National Institutes of Health (1R21DK118643-O1A1)