Barriers to Technology Use and Endocrinology Care for Underserved Communities With Type 1 Diabetes.
Barriers to Technology Use and Endocrinology Care for Underserved Communities With Type 1 Diabetes.
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DOI：
10.2337/dc20-2753
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发表时间：
2021-07
期刊：
影响因子：
16.2
通讯作者：
Maahs DM
中科院分区：
文献类型：
--
作者：
Walker AF;Hood KK;Gurka MJ;Filipp SL;Anez-Zabala C;Cuttriss N;Haller MJ;Roque X;Naranjo D;Aulisio G;Addala A;Konopack J;Westen S;Yabut K;Mercado E;Look S;Fitzgerald B;Maizel J;Maahs DM
根据社会经济地位(SES)、种族和民族的不同，与使用连续血糖监测仪(CGM)等技术和糖尿病护理利用相关的1型糖尿病差异显著。然而，来自脆弱社区患者关于障碍的系统报告有限。为了更好地了解障碍，在佛罗里达州和加利福尼亚州对患有1型糖尿病的18岁成年人进行了焦点小组调查，选择标准包括因糖尿病酮症酸中毒住院、糖化血红蛋白9%和/或在联邦合格健康中心接受治疗。16个焦点小组以英语或西班牙语进行，86名成年人(平均年龄42±16.2岁)。对成绩单主题和焦点前群体人口调查数据进行分析。按照频率顺序，糖尿病技术和内分泌护理的障碍包括1)提供者层面(消极提供者遭遇)，2)系统层面(财务覆盖范围)，以及3)个人层面(偏好)。超过50%的参与者在过去一年中没有看过内分泌科医生，或者只看过一次，包括在医院就诊期间。在佛罗里达州，使用技术的总体较少(在FL使用CGM的比例为38%，在CA为63%；在FL为43%，在CA为69%)；SES使用泵的情况有显著差异(FL为P=0.02；CA为P=0.08)和种族/民族(FL为P=0.01；CA为P=0.80)。在加利福尼亚州，不同种族/民族(CA组P=0.05；FL组P=0.56)和教育程度(CA组P=0.02；FL组P=0.90)的CGM使用率有显著差异。这些发现为弱势社区的经历提供了新的见解，并证明了旨在抵消糖尿病差异的多层次干预的必要性。
Disparities in type 1 diabetes related to use of technologies like continuous glucose monitors (CGMs) and utilization of diabetes care are pronounced based on socioeconomic status (SES), race, and ethnicity. However, systematic reports of perspectives from patients in vulnerable communities regarding barriers are limited. To better understand barriers, focus groups were conducted in Florida and California with adults ≥18 years old with type 1 diabetes with selection criteria including hospitalization for diabetic ketoacidosis, HbA1c >9%, and/or receiving care at a Federally Qualified Health Center. Sixteen focus groups were conducted in English or Spanish with 86 adults (mean age 42 ± 16.2 years). Transcript themes and pre–focus group demographic survey data were analyzed. In order of frequency, barriers to diabetes technology and endocrinology care included 1) provider level (negative provider encounters), 2) system level (financial coverage), and 3) individual level (preferences). Over 50% of participants had not seen an endocrinologist in the past year or were only seen once including during hospital visits. In Florida, there was less technology use overall (38% used CGMs in FL and 63% in CA; 43% used pumps in FL and 69% in CA) and significant differences in pump use by SES (P = 0.02 in FL; P = 0.08 in CA) and race/ethnicity (P = 0.01 in FL; P = 0.80 in CA). In California, there were significant differences in CGM use by race/ethnicity (P = 0.05 in CA; P = 0.56 in FL) and education level (P = 0.02 in CA; P = 0.90 in FL). These findings provide novel insights into the experiences of vulnerable communities and demonstrate the need for multilevel interventions aimed at offsetting disparities in diabetes.
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影响因子：
3.2
作者：
Hill, Kathleen E.;Gleadle, Jonathan M.;McNaughton, Darlene A.
通讯作者：
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影响因子：
3.2
作者：
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影响因子：
2.9
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影响因子：
16.2
作者：
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通讯作者：
Gudbjornsdottir, Soffia
影响因子：
44.5
作者：
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通讯作者：
Valabhji, Jonathan