Improving equity in diabetes technology use: Voices of youth and their parents

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM Diabetic Medicine Pub Date : 2024-06-17 DOI:10.1111/dme.15382

Amanda Perkins, Pamela S. Hinds, Jody B. Grundman, Seema Meighan, Maureen Monaghan, Randi Streisand, Brynn E. Marks

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Abstract

Aims

There are marked inequities in clinical outcomes and rates of diabetes technology use among youth with type 1 diabetes (T1D). The quantitative data from our mixed methods cohort study identified significant improvements in glycaemia and quality of life in participants. We aimed to use qualitative methods to provide further insight into our quantitative findings in the setting of underlying health disparities.

Methods

Fifteen publicly insured, insulin pump-naïve non-Hispanic Black youth aged 6–21 years with T1D and baseline haemoglobin A_1c (HbA_1c) ≥86 mmol/mol (10%) and their parents participated in a mixed methods cohort study. Semi-structured interviews were conducted separately with parents and youth after completion of 6 months of HCL use. Three topic areas were explored: (1) Experience using HCL, (2) barriers to HCL and (3) facilitators to accessing HCL. Semantic content analysis and consensus coding involving two team members were used to generate themes. Thematic saturation was achieved.

Results

Youth (Median_age 14.9 years, 67% female) and parents (92% female) were interviewed. Youth and their parents reported that access to HCL provides a new outlook on living with T1D, although managing T1D is still hard. They felt that diabetes technology is most helpful for those struggling with management. Participants experienced barriers to access including misconceptions of HCL systems, clinician bias and systemic racism. They suggested these barriers can be overcome by offering diabetes technology education for all people with T1D, increasing awareness of HCL in the community and providing resources to overcome barriers created by social determinants of health.

Conclusions

The voices of historically minoritised youth with suboptimal T1D control and their parents provide important, previously unreported experiences and perspectives on barriers and facilitators to using HCL that will shape interventions to improve equity in access to diabetes technology.

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提高糖尿病技术使用的公平性：青少年及其父母的心声。

目的：1 型糖尿病（T1D）青少年患者在临床结果和糖尿病技术使用率方面存在明显的不平等。我们的混合方法队列研究的定量数据表明，参与者的血糖和生活质量有了显著改善。我们旨在使用定性方法，在潜在健康差异的背景下进一步深入了解我们的定量研究结果：方法：15 名参加了公共保险、未使用过胰岛素泵的非西班牙裔黑人青少年（6-21 岁，患有 T1D，基线血红蛋白 A1c (HbA1c) ≥86 mmol/mol（10%））及其父母参加了一项混合方法队列研究。在使用 HCL 6 个月后，分别对父母和青少年进行了半结构式访谈。研究探讨了三个主题领域：（1）使用 HCL 的经验；（2）使用 HCL 的障碍；（3）使用 HCL 的促进因素。采用语义内容分析和有两名小组成员参与的共识编码来生成主题。主题饱和度已经达到：对青少年（中位数 14.9 岁，67% 为女性）和家长（92% 为女性）进行了访谈。青少年和他们的父母表示，尽管管理 T1D 仍然很困难，但获得 HCL 为 T1D 患者的生活提供了新的前景。他们认为，糖尿病技术对那些在管理方面挣扎的人最有帮助。参与者在使用过程中遇到了一些障碍，包括对 HCL 系统的误解、临床医生的偏见和系统性种族主义。他们建议，可以通过为所有 T1D 患者提供糖尿病技术教育、提高社区对 HCL 的认识以及提供资源以克服健康的社会决定因素所造成的障碍来克服这些障碍：对于使用 HCL 的障碍和促进因素，历史上 T1D 控制不佳的少数民族青少年及其父母的声音提供了重要的、以前未曾报道过的经验和观点，这些经验和观点将影响干预措施，以改善糖尿病技术的公平获取。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetic Medicine 医学-内分泌学与代谢

CiteScore

7.20

自引率

5.70%

发文量

229

审稿时长

3-6 weeks

期刊介绍： Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”