Background: While prior studies demonstrated disparities in access to diabetes technology based on race and socioeconomic status (SES) in children with T1D, few examined these differences in nationwide studies or in children with access to commercial health insurance.

Aim: To examine the difference in fill rates of insulin pumps and continuous glucose monitors (CGMs) among insured children with T1D from differential racial and SES groups.

Methods: Using medical and pharmacy claims from OptumLabs® Data Warehouse between 2011-2021, we calculated the proportion of children and adolescents <18 years with T1D with a fill for pump or CGM at cohort entry, overall and stratified by race/ethnicity and annual household income.

Results: We identified 13,267 children with T1D, of which 36% had CGMs and 30.1% had insulin pumps. In this population, non-Hispanic Whites (NHW) had higher rates of access to CGMs and insulin pumps than non-Hispanic Blacks (NHB) (CGMs: 35.7% vs 22.4%. Pumps: 31.8% vs 21%, p <0.001). Children whose household income was <$40k had lower rates of access to CGMs and pumps than those whose household income was >$200k (CGM 25.3% vs 43.7%. Pumps: 22.4% vs. 38.7%, p <0.0001). Within similar household incomes of <$40k, NHB were had CGM and insulin pump less often than NHW (CGM: 15.2% vs. 27.9%, p value 0.006. Pumps: 12.9% vs 25.5%, p 0.004). This racial difference disappeared with household income >$200k (CGMs: 47.5% for NHB vs. 43.1% for NHW and pumps: 45.9% for NHB and 38.2% for NHW, p 0.45 and 0.57 respectively).

Conclusion: In a cohort of commercially insured pediatric patients with T1D, race and income play a role in access to diabetes technology. The racial disparity becomes less prominent as household incomes increase, and virtually disappeared when household incomes exceeded $200k. NHB with household income <$40k are at the highest risk of being excluded from access to these critical technologies. Greater effort is needed at the systems and individual levels to mitigate these disparities.

Disclosure

A. Al Nofal: None. T. Rajjo: None. R. Basmaci: None. H. Heien: None. R.G. McCoy: Research Support; American Diabetes Association. Other Relationship; American Diabetes Association. Consultant; Wolters Kluwer Health. Research Support; National Institutes of Health, Patient-Centered Outcomes Research Institute. Consultant; Yale New Haven Health System.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institute of Health (NIH) (K23DK114497)

© 2024 by the American Diabetes Association
2024
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.