Racial Disparities in Diabetes Technology Use and Outcomes in Type 1 Diabetes in a Safety-Net Hospital
Open accessAbstract
Background Limited data exist regarding diabetes technology use among adults with type 1 diabetes (T1D) in urban racially/ethnically diverse safety-net hospitals. We examined racial/ethnic differences in the use of continuous glucose monitor (CGM) and continuous subcutaneous insulin infusion (CSII) in this setting. Methods A retrospective review of 227 patients ≥ 18 years of age with T1D seen in an urban, safety-net endocrinology clinic during 2016-2017 was completed (mean age: 39; 80% English-speaking; 50% had public insurance). Diabetes technology use, defined as either CGM or CSII or both CGM and CSII, and clinical outcomes were examined by race/ethnicity. Results Overall, 30% used CGM and 26% used CSII. After adjusting for age, language, insurance, and annual income, diabetes technology use in non-White patients was significantly lower than in White patients, predominantly lower in Black (aOR 0.25 [95% CI 0.11-0.56]) and patients identified as other race/ethnicity (aOR 0.30 [95% CI 0.11-0.77]). At the highest household income level (≥$75,000/y), Black and Hispanic individuals were significantly less likely than White individuals to use diabetes technology ( P P Conclusions Racial/ethnic disparities in diabetes technology use and glycemic control were observed even after adjusting for sociodemographic factors. Further research should explore barriers to accessing diabetes technology in non-White populations.
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Insulin pumps and CGM are less commonly used among groups who identify as racial or ethnic minorities, even after adjustment for socioeconomic and clinical factors.
“Insulin pumps and CGM are less commonly used among groups who identify as racial or ethnic minorities, even after adjustment for socioeconomic factors such as income and insurance status, and clinical factors such as healthcare utilization and diabetes self‐management.”
Previous studies have demonstrated associations between income, insurance status and Race on use of diabetes technologies.
“Although previous studies have demonstrated associations between income, insurance status and Race on use of diabetes technologies, 21 , 23 , 24 we are not aware of any previous studies applying an intersectional approach.”
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Khodabandehloo, P., Fakembe, P., Senga, J., Shulman, R., Lipscombe, L. L., Witteman, H. O., Banerjee, A., Presseau, J., Nakhla, M., Dogba, M. J., et al. (2025) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.16426 · Cited by 6 · see citing works
“Although previous studies have demonstrated associations between income, insurance status and Race on use of diabetes technologies, 21,23,24 we are not aware of any previous studies applying an intersectional approach.”
- Authors
- Fantasia, K. L., Wirunsawanya, K., Lee, C., & Rizo, I.
- Affiliations
- Boston University (US)
- Corresponding author
- Wirunsawanya, Kamonkiat
- Rizo, Ivania
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2021-03-10
- Volume
- 15
- Issue
- 5
- Pages
- 1010-1017
- ISSN
- 1932-2968 (ISSN-L)
- PMC
- PMC8442173
- OpenAlex
- W3134642622
- Cited by
- 62
- References
- 9
- Citations by year
- 2026: 12 · 2025: 14 · 2024: 16 · 2023: 7 · 2022: 9 · 2021: 4
- FWCI
- 6.72
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Diabetes Science and Technology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR001430)
- National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007201)
- National Center for Advancing Translational Sciences
- 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 disparities, diabetes technology use, continuous glucose monitoring, insulin pump therapy, glycemic control, HbA1c, safety-net hospitals, Black patients, Hispanic patients, diabetes technology access, household income
- MeSH terms
- Adult, Black or African American, Diabetes Mellitus, Type 1, Glycated Hemoglobin, Hispanic or Latino, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Retrospective Studies, Technology, White People, Healthcare Disparities, Safety-net Providers
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