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Dr Viral Shah Addresses Gap in T1D Technology Uptake


More efforts need to be made to remove unconscious bias when implementing approved diabetes technologies into clinical practice for all patients, said Viral Shah, MD, an endocrinologist and scientist.

Uptake in diabetes technology is lower among people in more diverse populations because of several factors, including a lack of representation in clinical trials and unconscious bias, according to Viral Shah, MD, endocrinologist and associate professor of medicine and pediatrics at the Barbara Davis Center for Diabetes, Adult Clinic School of Medicine at the University of Colorado Anschutz campus.


What are some changes that need to take place to achieve better health equity and reduce disparities in the uptake of diabetes technologies?

I think there are a number of publications that suggest that, unfortunately, the diabetes technology uptake has been low amongst the minority compared to the Whites in type 1 [diabetes] studies, and type 2s as well, suggest the same thing.

There are multiple reasons for that, I think, and we need to address all these multiple facets to reduce that kind of health care disparity in caring for patients with diabetes. And one of the aspects, and we published that in Diabetes Care last year, is that if you look at all this randomized controlled trial that forms the evidence to use these technologies in managing type 1 or type 2 diabetes, more than 70% of the participants in those clinical trials are Whites. And so unfortunately, when we are not recruiting minorities in a clinical trial, we don't know much about that how this technology is going to work in minorities. For example, the Spanish speaking people might need a screen that is in Spanish. They might have some kind of a different requirement to use that technology. So unless we study that, we don't know. And technology is not just about the science, but it's also about the human factor: how the patients are going to use that part, right? So I think I would suggest that companies should try to probably put some more resources in recruiting minorities in a clinical trial, so that we can understand how these things can work for them.

The second part of that is that once those technologies are available, approved, then how to implement that in a clinical practice so that we can use that for our patients—regardless of their skin color, regardless of their education level, regardless of the language that they speak. I think it will require a lot of efforts because I think there are some unconscious bias among physicians—among all of us. Unfortunately, we need to do more to remove that unconscious bias. There are multiple factors responsible for this gap, and if we can address those factors, I'm sure that we can reduce the disparity. But the first step is that you are asking the question; I feel like it's a first step that hey, we need to be aware about that. Once we are aware, then we'll think about closing the gap.

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