Al Nofal Alaa, Hassan Doha, Rajjo Tamim, Heien Herbert C, McCoy Rozalina G
Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota, USA.
Department of General Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
BMJ Open Diabetes Res Care. 2025 May 2;13(3):e004935. doi: 10.1136/bmjdrc-2025-004935.
Previous studies have demonstrated disparities in the utilization of diabetes technology among youth with type 1 diabetes (T1D) based on race and socioeconomic status (SES). Few studies have examined these differences on a national scale or among youth with commercial health insurance.
To investigate differences in the fill rates of insulin pumps and continuous glucose monitors (CGMs) among commercially insured children with T1D across diverse racial and SES groups.
Using medical and pharmacy claims included in the OptumLabs Data Warehouse, we calculated the proportion of youth <18 years with T1D who had a fill for an insulin pump or a CGM, overall and stratified by race/ethnicity and annual household income, between 2011 and 2021.
Among 13,246 youth with T1D, 36.1% had CGM and 30.9% had pump fills. White youth had higher CGM and pump fills than black (CGMs: 35.8% vs 22.5%; pumps: 31.9% vs 21.2%, p<0.001) and Hispanic (CGMs: 35.8% vs 32.6%, p=0.047; pumps: 31.9% vs 25.0%, p<0.001). Youth from households with income <US$40,000 had lower CGM and pump fills than those with income ≥US$200,000 (CGM 25.4% vs 43.8%; pumps: 22.4% vs 38.8%, p<0.001). Within similar incomes <US$40,000, black youth had fewer CGM and pump fills than white youth (CGM: 15.2% vs 27.9%, p=0.006; pumps: 12.9% vs 25.5%, p=0.004). This racial difference disappeared with income ≥US$200,000 (CGMs: 47.5% for black vs 43.1% for white; pumps: 45.9% for black vs 38.3% for white, p=0.45 and p=0.57, respectively).
In a cohort of commercially insured youth with T1D, both race and income are important factors that can independently influence the use of diabetes technology. Racial disparities decrease with higher income and disappear at incomes ≥US$200,000. Black youth with income <US$40,000 are at the highest exclusion risk from essential technologies. Greater effort is needed at both the system and individual levels to mitigate these disparities.
先前的研究表明，1型糖尿病（T1D）青少年在糖尿病技术的使用方面，存在基于种族和社会经济地位（SES）的差异。很少有研究在全国范围内或针对拥有商业医疗保险的青少年进行此类差异的研究。
调查不同种族和SES群体中，拥有商业医疗保险的T1D儿童胰岛素泵和连续血糖监测仪（CGM）的填充率差异。
利用OptumLabs数据仓库中的医疗和药房理赔数据，我们计算了2011年至2021年间，18岁以下患有T1D的青少年中，使用胰岛素泵或CGM的比例，总体情况以及按种族/族裔和家庭年收入分层的情况。
在13246名患有T1D的青少年中，36.1%使用CGM，30.9%使用胰岛素泵。白人青少年的CGM和胰岛素泵使用率高于黑人（CGM：35.8%对22.5%；胰岛素泵：31.9%对21.2%，p<0.001）和西班牙裔（CGM：35.8%对32.6%，p=0.047；胰岛素泵：31.9%对25.0%，p<0.001）。家庭收入低于40000美元的青少年，其CGM和胰岛素泵使用率低于收入≥200000美元的青少年（CGM：25.4%对43.8%；胰岛素泵：22.4%对38.8%，p<0.001）。在收入低于40000美元的类似群体中，黑人青少年的CGM和胰岛素泵使用率低于白人青少年（CGM：15.2%对27.9%，p=0.006；胰岛素泵：12.9%对25.5%，p=0.004）。当收入≥200000美元时，这种种族差异消失（CGM：黑人47.5%，白人43.1%；胰岛素泵：黑人45.9%，白人38.3%，p分别为0.45和0.57）。
在一组拥有商业医疗保险的T1D青少年中，种族和收入都是可以独立影响糖尿病技术使用的重要因素。种族差异随着收入增加而减小，在收入≥200000美元时消失。收入低于40000美元的黑人青少年被排除在基本技术使用之外的风险最高。需要在系统和个人层面做出更大努力来缓解这些差异。
