Abstract
Background: There are significant and pervasive inequities in the health outcomes of youth and young adults with type 1 diabetes (T1D). This review sought to examine 1) child and caregiver demographic and biopsychosocial variables associated with provider bias and outcomes (e.g., HbA1c; blood glucose values and range; diabetes technology use; burnout, stress, anxiety associated with T1D care); 2) evidence for associations between experiences of provider bias and patient physical and psychological outcomes; and 3) evidence for mediators or moderators (e.g., socioeconomic status, race/ethnicity) contributing to the association between provider bias and patient outcomes. Methods: A systematic review of the literature was conducted across five public electronic databases: PubMed, PsycINFO, CINAHL, Web of Science, Embase. Studies included youth/young adults with T1D with a mean age between 12-35 years that investigated the effects of provider bias on physical and psychological health outcomes. Results: Fourteen articles were included in the review. Results suggest experiences of provider bias (e.g., shaming, criticism) negatively affect individuals’ self-esteem, relationships with medical providers, and mood. Provider bias also impacts recommendations about diabetes technology use, insulin regimen intensity, and risk for life-threatening T1D complications. Conclusions: Evidence from the current review suggests that provider bias plays a role in adverse physical and mental health. Varying study methodology in definitions and assessment of provider bias signals a need for comprehensive measure development to account for diverse experiences and interpretations of bias in healthcare. More research is necessary to investigate intervening factors that may affect the association between provider bias and overall health outcomes in youth and young adults with T1D. Disclosure S.E.Wetter: None. A.C.Himelhoch: None. K.A.Driscoll: None.
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