Racial Disparities in Diabetes Technology Adoption and Their Association with HbA1c and Diabetic Ketoacidosis.

Poorer glycemic control and higher diabetic ketoacidosis (DKA) rates are seen in racial/ethnic minorities with type 1 diabetes (T1D). Use of diabetes technologies such as continuous glucose monitors (CGM), continuous subcutaneous insulin infusion (CSII) and automated insulin delivery (AID) systems has been shown to improve glycemic control and reduce DKA risk. We examined race/ethnicity differences in diabetes technology use and their relationship with HbA1c and DKA. Data from patients aged ≥12 years with T1D for ≥1 year, receiving care from a single diabetes center, were examined. Patients were classified as Non-Hispanic White (n=3945), Non-Hispanic Black (Black, n=161), Hispanic (n=719), and Multiracial/Other (n=714). General linear models and logistic regression were used. Black (OR=0.22, 0.15-0.32) and Hispanic (OR=0.37, 0.30-0.45) patients were less likely to use diabetes technology. This disparity was greater in the pediatric population (p-interaction=0.06). Technology use associated with lower HbA1c in each race/ethnic group. Among technology users, AID use associated with lower HbA1c compared to CGM and/or CSII (HbA1c of 8.4% vs 9.2%, respectively), with the greatest difference observed for Black adult AID users. CSII use associated with a lower odds of DKA in the past year (OR=0.73, 0.54-0.99), a relationship that did not vary by race (p-interaction =0.69); this inverse association with DKA was not observed for CGM or AID. Disparities in diabetes technology use, DKA, and glycemic control were apparent among Black and Hispanic patients with T1D. Differences in technology use ameliorated but did not fully account for disparities in HbA1c or DKA.

Informations de copyright

© 2023 Conway et al.

Déclaration de conflit d'intérêts

VNS’ employer, University of Colorado, has received research supports from NovoNordisk, Insulet, Tandem Diabetes Care, Dexcom, JDRF and NIH and received honoraria for advisory works for NovoNordisk, Medscape, Lifescan, and DKSH Singapore and from Dexcom, Embecta and Insulet for speaking. HKA’s employer, University of Colorado, received research support from Dexcom, Eli Lilly, Senseonics, Medtronic, Tandem, IM Therapeutics, REMD Biotherapeutics, received honoraria for advisory board attendance for Mannkind and Senseonics. GF reports grant and/or personal fees from Medtronic, Dexcom, Tandem, Insulet, Abbott, Lilly, and Beta Bionics, during the conduct of the study. The authors report no other conflicts of interest in this work.