3-OR: Racial/Ethnic Disparities in Diabetes Technology Use in Young Adults (YA) with Type 1 Diabetes (T1D): Multidisciplinary Stakeholder Perspectives and Solutions

Abstract

Background: Black and Hispanic YA with T1D are less likely to use insulin pumps and continuous glucose monitors than White peers, which may be contributing to disparities in glycemic and long-term outcomes. Methods: We conducted a series of interactive focus groups to elicit perspectives on racial/ethnic disparities in diabetes technology use, patient-centered barriers and facilitators, and solutions to enhance uptake. We invited multidisciplinary panels of stakeholders to participate, including YA T1D patients, physicians, nurses, psychologists, and community health workers. Sessions were recorded and analyzed for common themes. Results: We convened 7 virtual 2-hour workshops and recruited 32 stakeholders from 11 states (5 Black and 7 Hispanic YA, 20 other stakeholders). Notably, many patients stated that they had never been offered technology until recent engagement in a specialized YA T1D clinic. Once offered technology, multiple barriers were present across a chronological journey consisting of three phases: 1) learning about and deciding to get technology; 2) initiating use; and 3) managing ongoing problems. Some barriers included a lack of knowledge about devices, mismanaged expectations for device wearability and use, and insurance coverage benefits. Facilitators included family support, T1D peer partnership, and a supportive healthcare team. Co-created solutions to address barriers were categorized into four main themes: 1) more equitable system of offering technology; 2) visual and hands-on education; 3) peer support; and 4) insurance navigation assistance. Discussion: Engaging multiple stakeholders with lived experience of the problem is an important approach to diabetes disparities research. Inadvertent provider bias may be preventing equal access to technology for minority YA with T1D, while extra support for device use through the technology journey is needed to sustain use. Disclosure S. Agarwal: None. G. Crespo-ramos: None. S. Leung: None. M. Finnan: None. T. Park: None. J. S. Gonzalez: None. J. A. Long: None. Funding National Institutes of Health (K23DK115896)