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

Abstract

Rebecca Baqiyyah Conway,1 Andrea Gerard Gonzalez,2 Viral N Shah,2 Cristy Geno Rasmussen,2 Halis Kaan Akturk,2 Laura Pyle,2 Gregory Forlenza,2 Guy Todd Alonso,2 Janet Snell-Bergeon2 1Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; 2School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USACorrespondence: Rebecca Baqiyyah Conway, Colorado School of Public Health, Anschutz Medical Campus, 13001 East 17th Place, Mail Stop B119, Aurora, CO, 80045, USA, Email [email protected]: 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.Methods: 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.Results: 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.Conclusion: 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.Keywords: continuous subcutaneous insulin infusion, continuous glucose monitoring, automated insulin delivery systems, diabetic ketoacidosis, racial disparities

Keywords

• continuous subcutaneous insulin infusion
• continuous glucose monitoring
• automated insulin delivery systems
• diabetic ketoacidosis
• racial disparities