Diabetes technology (DT) use is associated with lower HbA1c levels in type 1 diabetes (T1D) . Non-Hispanic Black (NHB) and Hispanic populations with T1D have higher HbA1c levels and lower DT use compared to non-Hispanic white (NHW) populations. At our Pediatric Diabetes Center, DT use is high across all race and ethnicity groups, but disparities in outcomes remain. We sought to examine the extent to which DT use accounts for disparities.
We abstracted EHR data for patients ages 2-25 with T1D >/= 12 month duration. HbA1c >9% was categorized as high. Patients identifying as non-white, Hispanic, or whose preferred language was not English were grouped and compared to the NHW, English speaking group. T-test and chi-square statistics compared demographic and clinical characteristics by HbA1c category. Binomial regression with generalized estimating equations estimated risk ratios (RR; 95% confidence intervals; CI) for the association between minority race/language (MRL) and high HbA1c. First, models were adjusted for age and insurance type, then for CGM and pump use.
Data was collected over 13 months (2020-21) from 264 patients over 549 visits (mean 2.1, SD 1.2) . Thirty-three percent of patients identified as MRL. At their most recent visit, 19% had HbA1c >9% (MRL 36% vs. non-MRL 11%) , 86% used CGMs (MRL 73% vs. non-MRL 93%) , and 80% were using pumps (MRL 76% vs. non-MRL 81%) ; 95% of pump users also used CGMs. There was no difference in HbA1c category by number of visits, time since diagnosis, age, or sex. In regression models, MRL youth were 2.7 (95% CI 1.7-4.4) times more likely to be in the high HbA1c category as compared to non-MRL youth, adjusted for age and insurance. When also adjusting for CGM and pump use, MRL patients remained twice as likely to be in the high HbA1c category (RR 2.0, 95% CI 1.2-3.3) . While the disparity in HbA1c between MRL youth compared to non-MRL youth can be partially attributed to DT use, disparity persists even after accounting for use of DT.
C.R.Stein: None. J.Ilkowitz: None. J.E.Gonzalez: None. M.Gallagher: None.