University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio, USA.
University of Toledo General Internal Medicine Clinic and College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio, USA.
Diabetes Obes Metab. 2024 Oct;26(10):4293-4301. doi: 10.1111/dom.15774. Epub 2024 Jul 15.
This study aims to provide a comprehensive overview of real-world evidence pertaining to disparities in the utilization of continuous glucose monitors (CGMs)/insulin pumps to highlight potential evidentiary gaps and discern emerging themes from the literature.
A systematic review of published manuscripts and abstracts was conducted from: MEDLINE, EMBASE, Nursing and Allied Health, Web of Science and CINHAL. Attributes related to patients, outcomes, interventions (CGMs/pumps/both) and study type were captured. In addition, factors associated with disparities in device utilization were examined.
Thirty-six studies were included in the final analysis; the studies predominantly focused on people living with type 1 diabetes. Only two studies included individuals with type 2 diabetes. Almost two-thirds of the studies reported outcomes associated with disparities (e.g. glycated haemoglobin, diabetic ketoacidosis, resource utilization). Most studies highlighted disparities across race, ethnicity and insurance type. Evidentiary gaps were identified, particularly in the evidence for people with type 2 diabetes, the continuation of CGM/pump use and limited studies addressing disparities among Native Americans/American Indians.
This study reveals critical disparities in diabetes technology use across race, ethnicity and insurance type, particularly among people with type 1 diabetes. Evidentiary gaps assessing disparities in diabetes technology use persist, particularly concerning people with type 2 diabetes, Native American/American Indian and LGBTQ+ populations, and in outcomes related to continuation of use. Social and digital determinants of health, such as income, transportation, residential location and technological literacy, are crucial to achieving equitable access. Future research should focus on the patient journey to identify opportunities for equitable access to diabetes technology as its use grows.
本研究旨在提供关于连续血糖监测仪（CGM）/胰岛素泵使用差异的真实世界证据的综合概述，以突出潜在的证据差距，并从文献中识别新兴主题。
对已发表的文献进行了系统的综述，检索了 MEDLINE、EMBASE、护理和相关健康、Web of Science 和 CINHAL。捕获了与患者、结局、干预措施（CGM/泵/两者）和研究类型相关的属性。此外，还检查了与设备使用差异相关的因素。
最终分析纳入了 36 项研究；这些研究主要集中在 1 型糖尿病患者。只有两项研究纳入了 2 型糖尿病患者。近三分之二的研究报告了与差异相关的结局（例如糖化血红蛋白、糖尿病酮症酸中毒、资源利用）。大多数研究强调了种族、族裔和保险类型之间的差异。发现了证据差距，特别是在 2 型糖尿病患者的证据、CGM/泵使用的延续性以及有限的研究解决美洲原住民/印第安人的差异方面。
本研究揭示了糖尿病技术使用在种族、族裔和保险类型方面存在重大差异，特别是在 1 型糖尿病患者中。评估糖尿病技术使用差异的证据差距仍然存在，特别是在 2 型糖尿病患者、美洲原住民/印第安人和 LGBTQ+人群以及与使用延续性相关的结局方面。社会和数字健康决定因素，如收入、交通、居住地点和技术素养，对于实现公平获得至关重要。未来的研究应关注患者的就医历程，以确定在糖尿病技术使用不断增加的情况下实现公平获得的机会。
