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Cited by 182Diabetes Management and ResearchDiabetes Management and EducationDiabetes and associated disorders

Racial–Ethnic Disparities in Diabetes Technology use Among Young Adults with Type 1 Diabetes

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Agarwal, Shivani, Schechter, Clyde, Gonzalez, Jeffrey, Long, Judith A.·2021·Diabetes Technology & Therapeutics
DOI 10.1089/dia.2020.0338PMC PMC7994432
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Abstract

Background: Recent studies highlight racial–ethnic disparities in insulin pump and continuous glucose monitor (CGM) use in people with type 1 diabetes (T1D), but drivers of disparities remain poorly understood beyond socioeconomic status (SES). Methods: We recruited a diverse sample of young adults (YA) with T1D from six diabetes centers across the United States, enrolling equal numbers of non-Hispanic (NH) White, NH Black, and Hispanic YA. We used multivariate logistic regression to examine to what extent SES, demographics, health care factors (care setting, clinic attendance), and diabetes self-management (diabetes numeracy, self-monitoring of blood glucose, and Self-Care Inventory score) explained insulin pump and CGM use in each racial–ethnic group. Results: We recruited 300 YA with T1D, aged 18–28 years. Fifty-two percent were publicly insured, and the mean hemoglobin A1c was 9.5%. Large racial–ethnic disparities in insulin pump and CGM use existed: 72% and 71% for NH White, 40% and 37% for Hispanic, and 18% and 28% for NH Black, respectively. After multiple adjustment, insulin pump and CGM use remained disparate: 61% and 53% for NH White, 49% and 58% for Hispanic, and 20 and 31% for NH Black, respectively. Conclusions: Insulin pump and CGM use was the lowest in NH Black, intermediate in Hispanic, and highest in NH White YA with T1D. SES was not the sole driver of disparities nor did additional demographic, health care, or diabetes-specific factors fully explain disparities, especially between NH Black and White YA. Future work should examine how minority YA preferences, provider implicit bias, systemic racism, and mistrust of medical systems help to explain disparities in diabetes technology use.

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Sorted by citations

Authors
Agarwal, S., Schechter, C., Gonzalez, J., & Long, J. A.
Affiliations
  • Albert Einstein College of Medicine (US)
  • Philadelphia VA Medical Center (US)
Corresponding author
Agarwal, Shivani
ORCID
Venue
Diabetes Technology & Therapeutics
Publisher
SAGE Publications
Published
2021-03-22
Volume
23
Issue
4
Pages
306-313
ISSN
  • 1520-9156 (ISSN-L)
  • 1557-8593
DOI
10.1089/dia.2020.0338
PMC
PMC7994432
OpenAlex
W3095500348
Cited by
182
References
3
Citations by year
2026: 32 · 2025: 34 · 2024: 29 · 2023: 39 · 2022: 31 · 2021: 17
FWCI
16.40
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Diabetes Technology & Therapeutics (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896, P30DK111022)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords
type 1 diabetes, racial and ethnic disparities, continuous glucose monitoring, diabetes technology adoption, young adults, socioeconomic status, Black patients, Hispanic patients, diabetes self-management, self-monitoring of blood glucose, health care access
MeSH terms
Black or African American, Diabetes Mellitus, Type 1, Ethnicity, Glycated Hemoglobin, Hispanic or Latino, Humans, Insulin Infusion Systems, Technology, United States, White People, Health Status Disparities, Healthcare Disparities, Young Adult

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