This retrospective study sought to evaluate racial differences in prescribing and use of continuous glucose monitoring (CGM) and insulin pumps in adults with type 1 diabetes at the Johns Hopkins diabetes centre in Baltimore, MD, USA. Electronic records of 1258 people with type 1 diabetes (19.2% Black) between April 2013 and January 2020 were evaluated.
Significant racial disparities were observed for all outcomes, including discussion, prescription and use of CGM and pumps. Black participants were less likely to be using both CGM (44% vs 72%) and insulin pumps (31% vs 64%) during the follow-up compared with non-Black individuals.
Odds ratios were adjusted for social determinants of health (primary language, marital status, employment status, health insurance type, socioeconomic deprivation), mental health issues, legal and illegal substance use, diabetes outcomes and number of diabetes clinic visits, and this adjustment had little effect on the overall trends. Adjusted odds ratios in Black versus non-Black people were 0.51 for CGM discussion and 0.61 for CGM prescription, and 0.74 for pump discussion and 0.40 for pump prescription.
Although this study was conducted in the US, which has a different healthcare funding model to the UK, many of the causes of these racial disparities could occur independently of the type of healthcare system, and the authors call specifically for prospective studies to assess the impact on diabetes technology use of healthcare professional type, training and experience; racial concordance between professionals and patients; and the quantity and quality of patient consultations.
Attempts to achieve remission, or at least a substantial improvement in glycaemic control, should be the initial focus at type 2 diabetes diagnosis.
9 May 2024