A Retrospective Cohort Study of Racial/Ethnic and Socioeconomic Disparities in Initiation and Meaningful Use of Continuous Glucose Monitoring Among Youth With Type 1 Diabetes.

IF 4.1 Q2 ENDOCRINOLOGY & METABOLISM Journal of Diabetes Science and Technology Pub Date : 2024-11-01 Epub Date: 2023-07-03 DOI:10.1177/19322968231183985
Elise Schlissel Tremblay, Allison Bernique, Katherine Garvey, Christina M Astley
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Abstract

Background: Continuous glucose monitor (CGM) use improves type 1 diabetes (T1D) outcomes, yet children from diverse backgrounds and on public insurance have worse outcomes and lower CGM utilization. Using novel CGM data acquisition and analysis of two T1D cohorts, we test the hypothesis that T1D youth from different backgrounds experience disparities in meaningful CGM use following both T1D diagnosis and CGM uptake.

Methods: Cohorts drawn from a pediatric T1D program were followed for one year beginning at diagnosis (n = 815, 2016-2020) or CGM uptake (n = 1392, 2015-2020). Using chart and CGM data, CGM start and meaningful use outcomes between racial/ethnic and insurance groups were compared using median days, one-year proportions, and survival analysis.

Results: Publicly compared with privately insured were slower to start CGM (233, 151 days, P < .01), had fewer use-days in the year following uptake (232, 324, P < .001), and had faster first discontinuation rates (hazard ratio [HR] = 1.61, P < .001). Disparities were more pronounced among Hispanic and black compared with white subjects for CGM start time (312, 289, 149, P = .0013) and discontinuation rates (Hispanic HR = 2.17, P < .001; black HR = 1.45, P = .038), and remained even among privately insured (Hispanic/black HR = 1.44, P = .0286).

Conclusions: Given the impact of insurance and race/ethnicity on CGM initiation and use, it is imperative that we target interventions to support universal access and sustained CGM use to mitigate the potential impact of provider biases and systemic disadvantage and racism. By enabling more equitable and meaningful T1D technology use, such interventions will begin to alleviate outcome disparities between youth with T1D from different backgrounds.

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1型糖尿病青年持续血糖监测的启动和有意义使用的种族/民族和社会经济差异的回顾性队列研究。
背景:持续血糖监测仪(CGM)的使用改善了1型糖尿病(T1D)的预后,但来自不同背景和参加公共保险的儿童的预后更差,CGM的利用率更低。使用新的CGM数据采集和对两个T1D队列的分析,我们检验了来自不同背景的T1D青年在T1D诊断和CGM摄取后在有意义的CGM使用方面存在差异的假设。方法:从诊断(n=8152016-2020)或CGM摄取(n=13921915-2020)开始,对来自儿科T1D项目的队列进行为期一年的随访。使用图表和CGM数据,使用中位数天数、一年比例和生存率分析,比较种族/民族和保险组之间的CGM开始和有意义的使用结果。结果:与私人保险相比,公共保险开始CGM的速度较慢(233151天,P<0.01),在服用后的一年中使用天数较少(232324天,P<.001),并且首次停药率更快(危险比[HR]=1.61,P<.001)。与白人受试者相比,西班牙裔和黑人在CGM开始时间(31289149,P=.0013)和停药率(西班牙族HR=2.17,P<.001;黑人HR=1.45,P=.038)方面的差异更为明显,结论:鉴于保险和种族/民族对CGM启动和使用的影响,我们必须采取干预措施,支持普及和持续使用CGM,以减轻提供者偏见、系统性劣势和种族主义的潜在影响。通过使T1D技术的使用更加公平和有意义,这种干预措施将开始缓解来自不同背景的T1D青年之间的结果差异。
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来源期刊
Journal of Diabetes Science and Technology
Journal of Diabetes Science and Technology Medicine-Internal Medicine
CiteScore
7.50
自引率
12.00%
发文量
148
期刊介绍: The Journal of Diabetes Science and Technology (JDST) is a bi-monthly, peer-reviewed scientific journal published by the Diabetes Technology Society. JDST covers scientific and clinical aspects of diabetes technology including glucose monitoring, insulin and metabolic peptide delivery, the artificial pancreas, digital health, precision medicine, social media, cybersecurity, software for modeling, physiologic monitoring, technology for managing obesity, and diagnostic tests of glycation. The journal also covers the development and use of mobile applications and wireless communication, as well as bioengineered tools such as MEMS, new biomaterials, and nanotechnology to develop new sensors. Articles in JDST cover both basic research and clinical applications of technologies being developed to help people with diabetes.
期刊最新文献
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