Keywords
Insulin Pump
Diabetes
technology
Continuous Glucose Monitoring
Categories
How to Cite
Abstract
Introduction: Despite technological advances in Type 1 Diabetes Mellitus (T1D) management, racial disparities in insulin pump utilization persist. We investigated patterns of insulin pump adoption across different racial groups using a large-scale, multi-institutional database to quantify these disparities and identify potential intervention points.
Methods: We conducted a retrospective cohort study using the TriNetX research network, analyzing data from 978,665 T1D patients across 66 healthcare organizations. Propensity score matching was employed to balance cohorts, with a focused sub-analysis of Buffalo, NY (n=6,080) to examine regional variations in comparison to the United States nationwide present data.
Results: Nationwide data revealed significant racial disparities in insulin pump utilization, with White patients showing the highest adoption rate (11.74%) compared to Black or African American (AA) patients (4.056%). Buffalo cohort demonstrated higher overall adoption rates but maintained similar disparity patterns (White: 30.18%, Black or AA: 13.75%). Post-matching analysis confirmed these disparities persisted independent of demographic factors.
Conclusions: Our findings reveal significant racial disparities in insulin pump adoption, with regional variations suggesting the influence of institutional factors. These results highlight the need for targeted interventions to promote equitable access to diabetes technology and prevent the widening of health disparities in T1D care.
References
1. Syed FZ. Type 1 Diabetes Mellitus. Ann Intern Med. 2022: ITC33 [PMID: 35254878, https://doi.org/10.7326/AITC202203150]
2. Dayan CM, Besser REJ, Oram RA, Hagopian W, Vatish M, Bendor-Samuel O, Snape MD, Todd JA. Preventing type 1 diabetes in childhood. Science. 2021: 506 [PMID: 34326231, https://doi.org/10.1126/science.abi4742]
3. Zajec A, Trebusak Podkrajsek K, Tesovnik T, Sket R, Cugalj Kern B, Jenko Bizjan B, Smigoc Schweiger D, Battelino T, Kovac J. Pathogenesis of Type 1 Diabetes: Established Facts and New Insights. Genes (Basel). 2022: [PMID: 35456512, https://doi.org/10.3390/genes13040706]
4. Bluestone JA, Buckner JH, Herold KC. Immunotherapy: Building a bridge to a cure for type 1 diabetes. Science. 2021: 510 [PMID: 34326232, https://doi.org/10.1126/science.abh1654]
5. Tonnies T, Brinks R, Isom S, Dabelea D, Divers J, Mayer-Davis EJ, Lawrence JM, Pihoker C, Dolan L, Liese AD, Saydah SH, D'Agostino RB, Hoyer A, Imperatore G. Projections of Type 1 and Type 2 Diabetes Burden in the U.S. Population Aged <20 Years Through 2060: The SEARCH for Diabetes in Youth Study. Diabetes Care. 2023: 313 [PMID: 36580405, https://doi.org/10.2337/dc22-0945]
6. Lawrence JM, Divers J, Isom S, Saydah S, Imperatore G, Pihoker C, Marcovina SM, Mayer-Davis EJ, Hamman RF, Dolan L, Dabelea D, Pettitt DJ, Liese AD, Group SfDiYS. Trends in Prevalence of Type 1 and Type 2 Diabetes in Children and Adolescents in the US, 2001-2017. JAMA. 2021: 717 [PMID: 34427600, https://doi.org/10.1001/jama.2021.11165]
7. Rafferty J, Stephens JW, Atkinson MD, Luzio SD, Akbari A, Gregory JW, Bain S, Owens DR, Thomas RL. A retrospective epidemiological study of type 1 diabetes mellitus in wales, UK between 2008 and 2018. Int J Popul Data Sci. 2021: 1387 [PMID: 34007896, https://doi.org/10.23889/ijpds.v6i1.1387]
8. Wass JAH, Arlt W, Semple RK, Hammond P, Campbell F. Strategies for the Management of Type 1 Diabetes. In: Wass JAH, Arlt W, Semple RK, Wass J, Arlt W, Semple R, editors. Oxford Textbook of Endocrinology and Diabetes 3e: Oxford University Press; 2022. p. 2024-2031.
9. Janez A, Guja C, Mitrakou A, Lalic N, Tankova T, Czupryniak L, Tabak AG, Prazny M, Martinka E, Smircic-Duvnjak L. Insulin Therapy in Adults with Type 1 Diabetes Mellitus: a Narrative Review. Diabetes Ther. 2020: 387 [PMID: 31902063, https://doi.org/10.1007/s13300-019-00743-7]
10. Visser MM, Charleer S, Fieuws S, De Block C, Hilbrands R, Van Huffel L, Maes T, Vanhaverbeke G, Dirinck E, Myngheer N, Vercammen C, Nobels F, Keymeulen B, Mathieu C, Gillard P. Comparing real-time and intermittently scanned continuous glucose monitoring in adults with type 1 diabetes (ALERTT1): a 6-month, prospective, multicentre, randomised controlled trial. Lancet. 2021: 2275 [PMID: 34089660, https://doi.org/10.1016/S0140-6736(21)00789-3]
11. Varkevisser RDM, Birnie E, Mul D, van Dijk PR, Aanstoot HJ, Wolffenbuttel BHR, van der Klauw MM. Type 1 diabetes management: Room for improvement. J Diabetes. 2023: 255 [PMID: 36808864, https://doi.org/10.1111/1753-0407.13368]
12. Zaharieva DP, Messer LH, Paldus B, O'Neal DN, Maahs DM, Riddell MC. Glucose Control During Physical Activity and Exercise Using Closed Loop Technology in Adults and Adolescents with Type 1 Diabetes. Can J Diabetes. 2020: 740 [PMID: 33011134, https://doi.org/10.1016/j.jcjd.2020.06.003]
13. Pratley RE, Kanapka LG, Rickels MR, Ahmann A, Aleppo G, Beck R, Bhargava A, Bode BW, Carlson A, Chaytor NS, Fox DS, Goland R, Hirsch IB, Kruger D, Kudva YC, Levy C, McGill JB, Peters A, Philipson L, Philis-Tsimikas A, Pop-Busui R, Shah VN, Thompson M, Vendrame F, Verdejo A, Weinstock RS, Young L, Miller KM, Wireless Innovation for Seniors With Diabetes Mellitus Study G. Effect of Continuous Glucose Monitoring on Hypoglycemia in Older Adults With Type 1 Diabetes: A Randomized Clinical Trial. JAMA. 2020: 2397 [PMID: 32543682, https://doi.org/10.1001/jama.2020.6928]
14. Galindo RJ, Aleppo G. Continuous glucose monitoring: The achievement of 100 years of innovation in diabetes technology. Diabetes Res Clin Pract. 2020: 108502 [PMID: 33065179, https://doi.org/10.1016/j.diabres.2020.108502]
15. Laffel LM, Kanapka LG, Beck RW, Bergamo K, Clements MA, Criego A, DeSalvo DJ, Goland R, Hood K, Liljenquist D, Messer LH, Monzavi R, Mouse TJ, Prahalad P, Sherr J, Simmons JH, Wadwa RP, Weinstock RS, Willi SM, Miller KM, Teens CGMIi, Young Adults with TDSG, Cde. Effect of Continuous Glucose Monitoring on Glycemic Control in Adolescents and Young Adults With Type 1 Diabetes: A Randomized Clinical Trial. JAMA. 2020: 2388 [PMID: 32543683, https://doi.org/10.1001/jama.2020.6940]
16. Keyu G, Jiaqi L, Liyin Z, Jianan Y, Li F, Zhiyi D, Qin Z, Xia L, Lin Y, Zhiguang Z. Comparing the effectiveness of continuous subcutaneous insulin infusion with multiple daily insulin injection for patients with type 1 diabetes mellitus evaluated by retrospective continuous glucose monitoring: A real-world data analysis. Front Public Health. 2022: 990281 [PMID: 36091534, https://doi.org/10.3389/fpubh.2022.990281]
17. McAuley SA, Vogrin S, Lee MH, Paldus B, Trawley S, de Bock MI, Abraham MB, Bach LA, Burt MG, Cohen ND, Colman PG, Davis EA, Hendrieckx C, Holmes-Walker DJ, Jenkins AJ, Kaye J, Keech AC, Kumareswaran K, MacIsaac RJ, McCallum RW, Sims CM, Speight J, Stranks SN, Sundararajan V, Ward GM, Jones TW, O'Neal DN, Australian JC-LRG. Less Nocturnal Hypoglycemia but Equivalent Time in Range Among Adults with Type 1 Diabetes Using Insulin Pumps Versus Multiple Daily Injections. Diabetes Technol Ther. 2021: 460 [PMID: 33351699, https://doi.org/10.1089/dia.2020.0589]
18. Huo L, Deng W, Lan L, Li W, Shaw JE, Magliano DJ, Ji L. Real-World Application of Insulin Pump Therapy Among Patients With Type 1 Diabetes in China: A Cross-Sectional Study. Front Endocrinol (Lausanne). 2022: 891718 [PMID: 35757419, https://doi.org/10.3389/fendo.2022.891718]
19. Harper A, Aflatoony L, Wilson W, Wang W, editors. Exploring the Challenges and Potential Alternatives to Insulin Pump Technologies. Proceedings of the 14th EAI International Conference on Pervasive Computing Technologies for Healthcare; 2020.
20. Gu M. Effective Use of Insulin Pump in Patients with Type 1 Diabetes. The Journal of Korean Diabetes. 2020: 36 https://doi.org/10.4093/jkd.2020.21.1.36]
21. DemİR G, ÇUbukcu E, Akcay N. Problems in Insulin Pump Management and Suggestions for Solutions in Children and Adolescents with Type 1 Diabetes. Turkish Journal of Diabetes and Obesity. 2022: 187 https://doi.org/10.25048/tudod.1105407]
22. O'Donnell HK, Vigers T, Johnson SB, Pyle L, Wright N, Deeb LC, Driscoll KA. Pump It Up! A randomized clinical trial to optimize insulin pump self-management behaviors in adolescents with type 1 diabetes. Contemp Clin Trials. 2021: 106279 [PMID: 33440262, https://doi.org/10.1016/j.cct.2021.106279]
23. Boscari F, Avogaro A. Current treatment options and challenges in patients with Type 1 diabetes: Pharmacological, technical advances and future perspectives. Rev Endocr Metab Disord. 2021: 217 [PMID: 33755854, https://doi.org/10.1007/s11154-021-09635-3]
24. Almogbel E. Impact of insulin pump therapy on glycemic control among adult Saudi type-1 diabetic patients. An interview-based case-control study. J Family Med Prim Care. 2020: 1013 [PMID: 32318460, https://doi.org/10.4103/jfmpc.jfmpc_869_19]
25. Biester T, Schwandt A, Heidtmann B, Rami-Merhar B, Haak T, Festa A, Kostow S, Muller A, Monkemoller K, Danne T, Initiative DPV. Declining Frequency of Acute Complications Associated with Tubeless Insulin Pump Use: Data from 2,911 Patients in the German/Austrian Diabetes Patienten Verlaufsdokumentation Registry. Diabetes Technol Ther. 2021: 527 [PMID: 33684335, https://doi.org/10.1089/dia.2020.0675]
26. Agarwal S, Schechter C, Gonzalez J, Long JA. Racial-Ethnic Disparities in Diabetes Technology use Among Young Adults with Type 1 Diabetes. Diabetes Technol Ther. 2021: 306 [PMID: 33155826, https://doi.org/10.1089/dia.2020.0338]
27. Everett EM, Wright D, Williams A, Divers J, Pihoker C, Liese AD, Bellatorre A, Kahkoska AR, Bell R, Mendoza J, Mayer-Davis E, Wisk LE. A Longitudinal View of Disparities in Insulin Pump Use Among Youth with Type 1 Diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Technol Ther. 2023: 131 [PMID: 36475821, https://doi.org/10.1089/dia.2022.0340]
28. Lipman TH, Willi SM, Lai CW, Smith JA, Patil O, Hawkes CP. Insulin Pump Use in Children with Type 1 Diabetes: Over a Decade of Disparities. J Pediatr Nurs. 2020: 110 [PMID: 32889433, https://doi.org/10.1016/j.pedn.2020.08.007]
29. Kanbour S, Jones M, Abusamaan MS, Nass C, Everett E, Wolf RM, Sidhaye A, Mathioudakis N. Racial Disparities in Access and Use of Diabetes Technology Among Adult Patients With Type 1 Diabetes in a U.S. Academic Medical Center. Diabetes Care. 2023: 56 [PMID: 36378855, https://doi.org/10.2337/dc22-1055]
30. Carrillo-Iregui A, Lopez-Mitnik G, Cossio S, Garibay-Nieto N, Arheart KL, Messiah SE. Relationship between aminotransferases levels and components of the metabolic syndrome among multiethnic adolescents. J Pediatr Endocrinol Metab. 2010: 1253 [PMID: 21714459, https://doi.org/10.1515/jpem.2010.199]
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