1018-P: Disparities in Diabetes Technology Use in Youth with Diabetes

Abstract

Background: Diabetes technology can improve glycemic control and diabetes outcomes, but there are disparities in patient use. Aims: Identify racial, ethnic, and socioeconomic disparities in technology utilization and determine provider, patient, and parent identified barriers to this. Methods: Technology (continuous glucose monitors [CGM] and pump) usage and demographic data on patients at a large urban pediatric hospital were obtained from a clinical database. Providers (physicians, nurse practitioners, diabetes educators [CDEs]) completed a survey on diabetes technology prescribing habits. English and Spanish speaking patients ages 8 to 17 years with type 1 or type 2 diabetes on insulin and their guardians completed patient and parent specific surveys that assessed attitudes and perceived benefits and burdens of diabetes technology. Responses (16 physicians, 11 CDEs, 109 patients, 117 parents) were analyzed with Kruskal-Wallis tests. Results: From August 2020-2021, independent of socioeconomic status, non-Hispanic Black (NHB) and Hispanic children were less likely to be prescribed pump (odds ratio 0.40 and 0.35 respectively) or CGM (0.50 and 0.49) compared to non-Hispanic White (NHW) children. For pump eligibility, CDEs placed higher importance on subjective factors such as parental education, health literacy, and psycho-social stability (p value < 0.05) compared to physicians. Hispanic and NHB patients and parents learned about diabetes technology later after diagnosis compared to NHW group. Physicians and CDEs identified patient perceived barriers to CGM use (i.e., embarrassment and/or discomfort in wearing devices) as reasons for not discussing technology, though patients did not identify such factors as barriers. Conclusions: There are marked disparities in diabetes technology use among youth with diabetes. Families and providers perceive different barriers to utilization. This study adds perspective of patients with T2D as well as targeted recruitment of underrepresented minorities. Disclosure P.Singh: None. E.Grishman: None. D.Naranjo: None. L.S.Hynan: None. P.C.White: Consultant; Provention Bio, Inc. O.Gupta: None.