Youth with T1D of underrepresented race/ethnicity (URE) have lower pump/CGM use, higher A1c, and greater DKA risk; however, the correlation of social determinants of health (SDoH) and neighborhood-level factors to pump/CGM use and clinical outcomes are unknown. In this study, multivariable models were used to evaluate the association of race/ethnicity, SDoH factors, and area deprivation index (ADI, range 1-10 with 10 being most deprived neighborhood) with pump/CGM use, A1c, and DKA in 1,461 T1D youth (50% F, age 12.8 ± 3.6 yrs, A1c 8.7 ± 2.1%, 52% pump, 70% CGM) seen over a 1-yr period. Youth were less likely to use a pump if they were Black or Hispanic, had Medicaid or were uninsured, received government assistance (i.e., SSI, Temporary Assistance for Needy Families (TANF), WIC, SNAP), or lived in a higher ADI neighborhood. Youth were less likely to use CGM if they were Black or Hispanic, had Medicaid or were uninsured, or lived in a higher ADI neighborhood. Youth had higher DKA risk in the past year if they lived in a higher ADI neighborhood or had government assistance; however, pump and CGM use were associated with lower DKA risk (Figure 1). For every 1 unit increase in ADI, A1c increased by 0.09 (95% CI: 0.05, 0.13). A1c was 0.62 lower (95% CI: -0.82, -0.42) in pump users vs. not and 0.78 lower (95% CI: -0.99, -0.56) in CGM users vs. not. Advocacy efforts and QI projects promoting technology use in T1D youth of URE and lower SES may improve A1c and decrease risk of DKA.
E.R.Crain: None. R.Ramphul: None. A.Butler: None. X.C.Huang: None. C.G.Minard: None. M.J.Redondo: None. D.Desalvo: Consultant; Dexcom, Inc., Research Support; Insulet Corporation.
