Differences in positive expectancy of hybrid closed loop (HCL) insulin delivery systems do not explain racial differences in HCL use.
Differences in positive expectancy of hybrid closed loop (HCL) insulin delivery systems do not explain racial differences in HCL use.
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DOI：
10.1016/j.jcte.2023.100319
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发表时间：
2023-06
影响因子：
3
通讯作者：
Marks, Brynn E.
中科院分区：
文献类型：
--
作者：
Grundman, Jody B.;Perkins, Amanda;Monaghan, Maureen;Meighan, Seema;Streisand, Randi;Marks, Brynn E.
混合闭环（HCL）胰岛素给药系统改善了1型糖尿病（T1 D）青年患者的血糖和生活质量，但在使用中存在不公平现象。我们的目的是评估HCL系统的积极预期差异是否可以解释使用差异。15名公共保险的非西班牙裔黑人（NHB）青年（血红蛋白A1 C（HbA 1c）≥ 10%）入组了一项研究，该研究探索了Tandem t：slim X2胰岛素泵（采用Control-IQ技术）6个月期间的血糖和个人报告结局（PRO）变化。在基线时，青少年和父母完成PRO，包括胰岛素输送系统：感知，想法，反思和期望（INSPIRE）调查评估HCL使用的积极预期，以及糖尿病问题领域（PAID）调查评估糖尿病相关的痛苦。评估了该队列与Tandem Control-IQ儿科关键性试验（DCLP 5）队列之间的差异。与DCLP 5队列（0% NHB，10%公共保险）相比，基线血糖指标次优（MHbA 1c 11.9 ± 1.4% vs 7.6 ± 0.9%，p < 0.0001;动态血糖监测（CGM）> 180 mg/dL的时间高于范围82 ± 15% vs 45 ± 18%，p < 0.0001）。两个队列的INSPIRE评分在青少年（80 ± 10 vs 77 ± 13，p = 0.41）和父母（88 ± 14 vs 85 ± 11，p = 0.37）中同样高。与DCLP 5队列相比，在历史边缘化队列中，父母的PAID评分较高（68 ± 19 vs 43 ± 16，p < 0.0001），但青年人的PAID评分不高（43 ± 16 vs 35 ± 16，p = 0.09）。尽管血糖控制和糖尿病相关负担存在差异，但在历史上被边缘化的T1 D青年和主要为非西班牙裔白色、私人保险的DCLP 5队列中，HCL系统的积极预期相当。这些研究结果表明，对HCL技术的看法差异可能无法解释使用中的不公平现象。
Hybrid closed loop (HCL) insulin delivery systems improve glycemia and quality of life among youth with type 1 diabetes (T1D), however there are inequities in use. We aimed to evaluate whether differences in positive expectancy of HCL systems may explain differences in use. Fifteen publicly-insured, non-Hispanic Black (NHB) youth with hemoglobin A1C (HbA1c) ≥ 10% enrolled in a study exploring changes in glycemia and person reported outcomes (PRO) during 6 months of Tandem t:slim X2 insulin pump with Control-IQ technology. At baseline youth and parents completed PROs, including Insulin Delivery Systems: Perceptions, Ideas, Reflections and Expectations (INSPIRE) survey assessing positive expectancy of HCL use, and Problem Areas in Diabetes (PAID) survey assessing diabetes-related distress. Differences between this cohort and the Tandem Control-IQ pediatric pivotal trial (DCLP5) cohort were assessed. As compared to the DCLP5 cohort (0% NHB, 10% publicly-insured), baseline glycemic indicators were suboptimal (MHbA1c 11.9 ± 1.4% vs 7.6 ± 0.9%, p < 0.0001; continuous glucose monitor (CGM) time-above-range > 180 mg/dL 82 ± 15% vs 45 ± 18%, p < 0.0001). INSPIRE scores in both cohorts were equally high among youth (80 ± 10 vs 77 ± 13, p = 0.41) and parents (88 ± 14 vs 85 ± 11, p = 0.37). PAID scores were higher among parents (68 ± 19 vs 43 ± 16, p < 0.0001), but not youth (43 ± 16 vs 35 ± 16, p = 0.09) in the historically marginalized cohort as compared to the DCLP5 cohort. Despite differences in glycemic control and diabetes related burden, positive expectancy of HCL systems is comparable among historically marginalized youth with T1D and the predominantly non-Hispanic White, privately insured DCLP5 cohort. These findings suggest that differences in perceptions of HCL technology may not explain inequities in use.
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