Racial-Ethnic Disparities in Diabetes Technology Use Among Young Adults with Type 1 Diabetes
Racial-Ethnic Disparities in Diabetes Technology Use Among Young Adults with Type 1 Diabetes
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DOI：
10.1089/dia.2020.0338
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发表时间：
2020-12-01
影响因子：
5.4
通讯作者：
Long, Judith A.
中科院分区：
文献类型：
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作者：
Agarwal, Shivani;Schechter, Clyde;Long, Judith A.
背景：最近的研究强调了 1 型糖尿病 (T1D) 患者在胰岛素泵和连续血糖监测仪 (CGM) 使用方面的种族差异，但除了社会经济地位 (SES) 之外，人们对差异的驱动因素仍然知之甚少。方法：我们从美国六个糖尿病中心招募了不同数量的 T1D 年轻人 (YA) 样本，招募了同等数量的非西班牙裔 (NH) 白人、NH 黑人和西班牙裔 YA。我们使用多变量逻辑回归来检验社会经济地位、人口统计、医疗保健因素（护理环境、诊所就诊）和糖尿病自我管理（糖尿病计算能力、血糖自我监测和自我护理量表评分）在多大程度上解释每个种族群体中胰岛素泵和 CGM 的使用。 结果：我们招募了 300 名 18-28 岁的 1D 青少年患者。 52% 的人参加了公共保险，平均糖化血红蛋白为 9.5%。胰岛素泵和 CGM 使用方面存在巨大的种族差异：NH 白人分别为 72% 和 71%，西班牙裔为 40% 和 37%，NH 黑人为 18% 和 28%。经过多次调整后，胰岛素泵和 CGM 的使用率仍然存在差异：NH 白人分别为 61% 和 53%，西班牙裔为 49% 和 58%，NH 黑人为 20 和 31%。结论：胰岛素泵和 CGM 使用率在 NH 黑人中最低，在西班牙裔中居中，在患有 T1D 的 NH 白人中最高。社会经济地位并不是差异的唯一驱动因素，其他人口、医疗保健或糖尿病特定因素也不能完全解释差异，尤其是新罕布什尔州黑人和白人青年之间的差异。未来的工作应该研究少数群体的青少年偏好、提供者的隐性偏见、系统性种族主义和对医疗系统的不信任如何有助于解释糖尿病技术使用的差异。
Background: Recent studies highlight racial-ethnic disparities in insulin pump and continuous glucose monitor (CGM) use in people with type 1 diabetes (T1D), but drivers of disparities remain poorly understood beyond socioeconomic status (SES).Methods: We recruited a diverse sample of young adults (YA) with T1D from six diabetes centers across the United States, enrolling equal numbers of non-Hispanic (NH) White, NH Black, and Hispanic YA. We used multivariate logistic regression to examine to what extent SES, demographics, health care factors (care setting, clinic attendance), and diabetes self-management (diabetes numeracy, self-monitoring of blood glucose, and Self-Care Inventory score) explained insulin pump and CGM use in each racial-ethnic group.Results: We recruited 300 YA with T1D, aged 18-28 years. Fifty-two percent were publicly insured, and the mean hemoglobin A1c was 9.5%. Large racial-ethnic disparities in insulin pump and CGM use existed: 72% and 71% for NH White, 40% and 37% for Hispanic, and 18% and 28% for NH Black, respectively. After multiple adjustment, insulin pump and CGM use remained disparate: 61% and 53% for NH White, 49% and 58% for Hispanic, and 20 and 31% for NH Black, respectively.Conclusions: Insulin pump and CGM use was the lowest in NH Black, intermediate in Hispanic, and highest in NH White YA with T1D. SES was not the sole driver of disparities nor did additional demographic, health care, or diabetes-specific factors fully explain disparities, especially between NH Black and White YA. Future work should examine how minority YA preferences, provider implicit bias, systemic racism, and mistrust of medical systems help to explain disparities in diabetes technology use.