Disparities Persist in Insulin Pump Uptake in Youth With T1D

Despite the increased prevalence of insulin pump use over the past 2 decades, there have been few improvements in uptake of the devices among patients who are Black or who come from lower socioeconomic levels.

A recent study shows few improvements in the ethnic, racial, and socioeconomic inequities in insulin pump use among youth with type 1 diabetes (T1D), building on previous studies with similar findings.

Researchers presented the study at ENDO 2022, the annual meeting of the Endocrine Society.

The serial cross-sectional analysis used data from population-based SEARCH for Diabetes in Youth Study to determine whether inequities in the use of insulin pumps for T1D have increased or diminished over time.

Changes over time in insulin pump use for T1D were evaluated for participants less than 20 years old by racial and ethnic group, health insurance, household income, and level of parental education across 4 time periods: 2001-2005; 2006-2010; 2011-2015; and 2016-2019.

Models used were adjusted for other predictors including age at each visit, diabetes duration, sex, and clinic site in the estimation of probability of insulin pump use.

Overall prevalence of insulin pump use increased to 58.3% in 2016-2019 from 30% in 2001-2006. And Hispanic patients saw some improvement: the adjusted odds ratio (OR) for pump use in this group was 0.08 (95% CI, 0.01-0.63) in 2001-2006 and 0.65 (95% CI, 0.48-0.87) in 2016-2019, a statistically significant improvement (P = .004).

However, when looking at the data by race and income and other factors, and comparing the results with Whites, large gaps became evident as no improvements were seen throughout any of the time periods in this study.

The OR for Black and other races was 0.28 (95% CI, 0.21-0.37; P = .864) and 0.43 (95% CI; 0.26-0.71; P =.439) and did not change through the course of the study.

Adjusted OR for pump use in those with some high school/high school degree and those with some college was 0.38 (95% CI; 0.30-0.48; P = .160) and 0.69 (95% CI; 0.57-0.82; P = .894) and did not change over time, compared with those whose parents had a a bachelor’s degree or more.

Compared with those with private health insurance, those with public health insurance had an OR for pump use of 0.84 (0.68-1.03; P = .815)

Compared with those with an annual household income of >$75,000, those with an income of <$25,000 $25,000-$49,000, and $50,000-$74,000 had an OR for pump use of 0.43 (95% CI, 0.34-0.54; P = .937), 0.57 (95% CI; 0.46-0.71; P = .870), and 0.80 (95% CI; 0.65-0.97; P = .821) respectively,

The results show that there have been few improvements in the ethnic, racial, and socioeconomic inequities in insulin pump use among youth with T1D over the past 2 decades.

“Studies that evaluate barriers or test interventions to improve technology access are needed to address the persistent inequities in diabetes care,” wrote the authors.

Reference

Everett E, Wright D, Williams A, et al. Assessing longitudinal disparities in insulin pump use among youth with type 1 diabetes. Presented at: ENDO 2022. June 14, 2022. Atlanta, Georgia.