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Use of Diabetes Devices Varies Widely by Race in Medicare Enrollees With Type 1

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Use of Diabetes Devices Varies Widely by Race in Medicare Enrollees With Type 1

Black Medicare enrollees with type 1 diabetes are much less likely than white enrollees to use devices like insulin pumps and continuous glucose monitoring (CGM) systems, according to a new study published in the Journal of Clinical Endocrinology & Metabolism.

Diabetes — particularly type 2 — is known to disproportionately affect Black Americans in several different ways. A study earlier this year found that Black people experience the greatest burden of diabetes among all racial or ethnic groups in the 30 largest U.S. cities, including a higher risk of death if they have diabetes. In fact, the gap in death rates between white and Black Americans with diabetes has grown larger in many cities in recent years, including Chicago, Los Angeles, and Oklahoma City. The largest racial gap in diabetes mortality was seen in Washington, DC, where Black residents were almost seven times as likely to die of diabetes-related causes as white residents. There is also some evidence that certain indicators of health risks may work differently in Black and white Americans — for example, an increase in waist size helped predict the risk for developing type 2 diabetes in Black adults with normal blood glucose levels in a recent study.

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For the latest study, researchers were interested in whether recent trends in use of devices like insulin pumps and CGM systems were different in Black and white Americans on Medicare — the U.S. federal health insurance program for people ages 65 and older, and some younger people with disabilities or certain health conditions. They used a Medicare database from 2017 to 2019 that showed whether people with type 1 used these devices, as well as enrollees’ race and ethnicity, sex, age, and visits to endocrinologists.

Racial disparities in insulin pump, CGM use

Over the two-year study period, use of insulin pumps and CGM systems increased in all racial and ethnic groups, as noted in an article on the study at MedPage Today. But among Black enrollees, the rate of using insulin pumps increased from just 3.8% to 4.6%, while among white enrollees, the rate increased from 14% to 18%. For CGM, the rate of use among Black enrollees increased from 4% to 12% between 2018 and 2019, reflecting changes to guidelines that encouraged CGM for more people. But white people saw an even greater increase in CGM use, from 14% in 2018 to 25% in 2019.

The study didn’t examine the reasons for these racial disparities in detail, but the researchers noted several reasons why they may exist — starting with a lack of standardized, evidence-based criteria for who would use an insulin pump or CGM system. Some doctors use criteria like needing to check blood glucose a certain number of times each day, reaching a certain A1C level (a measure of long-term blood glucose control), or having a minimum duration of diabetes — none of which have been shown to correlate with benefiting from using an insulin pump or CGM system. What’s more, there may be “unconscious bias among healthcare providers who may feel that people of color may not be able to use these technologies,” said study author Robert Vigersky, MD, chief medical officer at Medtronic Diabetes, in a press release. “In addition, there are cultural barriers, low health literacy and limited access to healthcare, particularly to endocrinologists.”

While standardized, evidence-based guidelines could help reduce some of the racial disparities in use of insulin pumps and CGM systems, such a change likely wouldn’t eliminate them entirely due to other factors that limit access to health care for many members of racial minority groups. “We need to address the social determinants of health, including race and ethnicity, before all aspects of diabetes care become more equitable,” said Vigersky in the press release.

Want to learn more about insulin pumps and CGM systems? Read “CGM for Diabetes Management,” “Ways to Deliver Insulin: Inhalers and Insulin Pumps,” and “How to Pick an Insulin Pump or CGM.”

Quinn Phillips

Quinn Phillips

Quinn Phillips on social media

A freelance health writer and editor based in Wisconsin, Phillips has a degree from Harvard University. He is a former Editorial Assistant for Diabetes Self-Management and has years of experience covering diabetes and related health conditions. Phillips writes on a variety of topics, but is especially interested in the intersection of health and public policy.

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