1265-P: The Paradox of Care Delivery for Type 1 Diabetes in Primary Care Settings: A Call for Interventions to Reduce Health Disparities

Abstract

Adults and children with type 1 diabetes (T1D) in the U.S. do not meet targets for HbA1c. These deficits are even more pronounced based on race/ethnicity and socioeconomic status (SES). Most studies on T1D health outcomes focus on data from endocrinology clinics, yet, primary care clinics play a central role in the management of patients, especially those affected by health disparities. To better understand barriers for individuals with T1D in primary care settings, survey research was conducted with 110 Primary Care Providers (PCPs) in Florida (n=52) and California (n=58) using publicly available state-wide provider directories. Surveys were completed by PCPs in a range of settings including solo (20%), multi-specialty group (35%), single-specialty group (21%), hospital/hospital-owned systems (12%) and ‘other’ (12%). For pediatric T1D populations, 58% of PCPs reported referring children to endocrinologists for diabetes care and only 45% checked HbA1c for children with T1D during clinic visits. For adult T1D populations, 30% of PCPs referred patients to endocrinologists and 65% checked for HbA1c. Overall, providers expressed a lack of confidence in caring for T1D patients, especially when it came to technologies like CGMs (only 28% said they were “moderately” or “extremely” confident herein) and insulin pumps (only 17% said they were “moderately” or “extremely” confident). The lack of confidence surrounding diabetes-technologies was especially evident for PCPs in practice 1-10 years or 31+ years (p<.05 for CGMs and p<.01 for pumps). Despite the lack of confidence in caring for patients with T1D, 73% of PCPs reported filling an insulin prescription for a T1D patient in the last year. Surveys with PCPs from a range of clinical settings demonstrate gaps in delivering standard of care and concurrently reveal the critical role PCPs play in T1D care. Efforts to improve outcomes in T1D must include targeted interventions in primary care settings. Disclosure A.F. Walker: None. N. Cuttriss: None. M.J. Haller: Advisory Panel; Self; Pancreum, SAB Biotherapeutics. K. Yabut: None. C. Anez-Zabala: None. R. Lal: Consultant; Self; Abbott. E. Sheehan: None. M. Basina: None. K.K. Hood: Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc. Speaker's Bureau; Self; Johnson & Johnson Diabetes Institute. A. Bernier: None. L.G. Baer: None. S.L. Filipp: None. C. Wang: None. M. Town: None. M.J. Gurka: None. D.M. Maahs: Advisory Panel; Self; Novo Nordisk Inc. Consultant; Self; Abbott, Sanofi. Research Support; Self; Dexcom, Inc., Tandem Diabetes Care. Funding The Leona M. and Harry B. Helmsley Charitable Trust