Fantasia Kathryn L, Wirunsawanya Kamonkiat, Lee Christopher, Rizo Ivania
Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
J Diabetes Sci Technol. 2021 Sep;15(5):1010-1017. doi: 10.1177/1932296821995810. Epub 2021 Mar 10.
Limited data exist regarding diabetes technology use among adults with type 1 diabetes (T1D) in urban racially/ethnically diverse safety-net hospitals. We examined racial/ethnic differences in the use of continuous glucose monitor (CGM) and continuous subcutaneous insulin infusion (CSII) in this setting.
A retrospective review of 227 patients ≥ 18 years of age with T1D seen in an urban, safety-net endocrinology clinic during 2016-2017 was completed (mean age: 39; 80% English-speaking; 50% had public insurance). Diabetes technology use, defined as either CGM or CSII or both CGM and CSII, and clinical outcomes were examined by race/ethnicity.
Overall, 30% used CGM and 26% used CSII. After adjusting for age, language, insurance, and annual income, diabetes technology use in non-White patients was significantly lower than in White patients, predominantly lower in Black (aOR 0.25 [95% CI 0.11-0.56]) and patients identified as other race/ethnicity (aOR 0.30 [95% CI 0.11-0.77]). At the highest household income level (≥$75,000/y), Black and Hispanic individuals were significantly less likely than White individuals to use diabetes technology ( < .0007). Mean hemoglobin A1c (HbA1c) was lower in patients using any diabetes technology compared with patients using no technology ( < .0001). Use of CGM and CSII together was associated with the lowest HbA1c across all racial/ethnic groups.
Racial/ethnic disparities in diabetes technology use and glycemic control were observed even after adjusting for sociodemographic factors. Further research should explore barriers to accessing diabetes technology in non-White populations.
关于城市中种族/民族多样化的安全网医院里成年1型糖尿病（T1D）患者使用糖尿病技术的数据有限。我们研究了在这种情况下连续血糖监测（CGM）和持续皮下胰岛素输注（CSII）使用方面的种族/民族差异。
对2016 - 2017年期间在一家城市安全网内分泌诊所就诊的227名≥18岁的T1D患者进行了回顾性研究（平均年龄：39岁；80%说英语；50%有公共保险）。按种族/民族检查糖尿病技术的使用情况（定义为使用CGM或CSII或同时使用CGM和CSII）以及临床结果。
总体而言，30%的患者使用CGM，26%的患者使用CSII。在调整年龄、语言、保险和年收入后，非白人患者的糖尿病技术使用率显著低于白人患者，黑人患者（调整后比值比[aOR]0.25[95%置信区间（CI）0.11 - 0.56]）和被认定为其他种族/民族的患者（aOR 0.30[95%CI 0.11 - 0.77]）的使用率尤其低。在家庭收入最高水平（≥75,000美元/年）时，黑人和西班牙裔个体使用糖尿病技术的可能性显著低于白人个体（P <.0007）。与未使用任何糖尿病技术的患者相比，使用任何糖尿病技术的患者的平均糖化血红蛋白（HbA1c）较低（P <.0001）。在所有种族/民族群体中，同时使用CGM和CSII与最低的HbA1c相关。
即使在调整社会人口统计学因素后，仍观察到糖尿病技术使用和血糖控制方面的种族/民族差异。进一步的研究应探索非白人人群获取糖尿病技术的障碍。
