Investigating Racial Disparities in Insulin Pump Use Among People with Type 1 Diabetes Across the United States: A Retrospective Multicenter Study
U.S vs Buffalo Abstract figure
PDF

Keywords

Racial Disparity
Insulin Pump
Diabetes
technology
Continuous Glucose Monitoring

Categories

How to Cite

1.
Nassar M, Azzam AY, Morsy MM, Patoli I, Gill A, Marte E. Investigating Racial Disparities in Insulin Pump Use Among People with Type 1 Diabetes Across the United States: A Retrospective Multicenter Study. ASIDE Int Med. 2024;1(1):20-25. doi:10.71079/ASIDE.IM.0000012262412

Abstract

Introduction: Despite technological advances in Type 1 Diabetes Mellitus (T1D) management, racial disparities in insulin pump utilization persist. We investigated patterns of insulin pump adoption across different racial groups using a large-scale, multi-institutional database to quantify these disparities and identify potential intervention points.

Methods: We conducted a retrospective cohort study using the TriNetX research network, analyzing data from 978,665 T1D patients across 66 healthcare organizations. Propensity score matching was employed to balance cohorts, with a focused sub-analysis of Buffalo, NY (n=6,080) to examine regional variations in comparison to the United States nationwide present data.

Results: Nationwide data revealed significant racial disparities in insulin pump utilization, with White patients showing the highest adoption rate (11.74%) compared to Black or African American (AA) patients (4.056%). Buffalo cohort demonstrated higher overall adoption rates but maintained similar disparity patterns (White: 30.18%, Black or AA: 13.75%). Post-matching analysis confirmed these disparities persisted independent of demographic factors.

Conclusions: Our findings reveal significant racial disparities in insulin pump adoption, with regional variations suggesting the influence of institutional factors. These results highlight the need for targeted interventions to promote equitable access to diabetes technology and prevent the widening of health disparities in T1D care.

PDF

References

1. Syed FZ. Type 1 Diabetes Mellitus. Ann Intern Med. 2022: ITC33 [PMID: 35254878 10.7326/AITC202203150: 10.7326/AITC202203150]

2. Dayan CM, Besser REJ, Oram RA, Hagopian W, Vatish M, Bendor-Samuel O, Snape MD, Todd JA. Preventing type 1 diabetes in childhood. Science. 2021: 506 [PMID: 34326231 10.1126/science.abi4742: 10.1126/science.abi4742]

3. Zajec A, Trebusak Podkrajsek K, Tesovnik T, Sket R, Cugalj Kern B, Jenko Bizjan B, Smigoc Schweiger D, Battelino T, Kovac J. Pathogenesis of Type 1 Diabetes: Established Facts and New Insights. Genes (Basel). 2022: [PMID: 35456512 10.3390/genes13040706: 10.3390/genes13040706]

4. Bluestone JA, Buckner JH, Herold KC. Immunotherapy: Building a bridge to a cure for type 1 diabetes. Science. 2021: 510 [PMID: 34326232 10.1126/science.abh1654: 10.1126/science.abh1654]

5. Tonnies T, Brinks R, Isom S, Dabelea D, Divers J, Mayer-Davis EJ, Lawrence JM, Pihoker C, Dolan L, Liese AD, Saydah SH, D'Agostino RB, Hoyer A, Imperatore G. Projections of Type 1 and Type 2 Diabetes Burden in the U.S. Population Aged <20 Years Through 2060: The SEARCH for Diabetes in Youth Study. Diabetes Care. 2023: 313 [PMID: 36580405 10.2337/dc22-0945: 10.2337/dc22-0945]

6. Lawrence JM, Divers J, Isom S, Saydah S, Imperatore G, Pihoker C, Marcovina SM, Mayer-Davis EJ, Hamman RF, Dolan L, Dabelea D, Pettitt DJ, Liese AD, Group SfDiYS. Trends in Prevalence of Type 1 and Type 2 Diabetes in Children and Adolescents in the US, 2001-2017. JAMA. 2021: 717 [PMID: 34427600 10.1001/jama.2021.11165: 10.1001/jama.2021.11165]

7. Rafferty J, Stephens JW, Atkinson MD, Luzio SD, Akbari A, Gregory JW, Bain S, Owens DR, Thomas RL. A retrospective epidemiological study of type 1 diabetes mellitus in wales, UK between 2008 and 2018. Int J Popul Data Sci. 2021: 1387 [PMID: 34007896 10.23889/ijpds.v6i1.1387: 10.23889/ijpds.v6i1.1387]

8. Wass JAH, Arlt W, Semple RK, Hammond P, Campbell F. Strategies for the Management of Type 1 Diabetes. In: Wass JAH, Arlt W, Semple RK, Wass J, Arlt W, Semple R, editors. Oxford Textbook of Endocrinology and Diabetes 3e: Oxford University Press; 2022. p. 2024-2031.

9. Janez A, Guja C, Mitrakou A, Lalic N, Tankova T, Czupryniak L, Tabak AG, Prazny M, Martinka E, Smircic-Duvnjak L. Insulin Therapy in Adults with Type 1 Diabetes Mellitus: a Narrative Review. Diabetes Ther. 2020: 387 [PMID: 31902063 10.1007/s13300-019-00743-7: 10.1007/s13300-019-00743-7]

10. Visser MM, Charleer S, Fieuws S, De Block C, Hilbrands R, Van Huffel L, Maes T, Vanhaverbeke G, Dirinck E, Myngheer N, Vercammen C, Nobels F, Keymeulen B, Mathieu C, Gillard P. Comparing real-time and intermittently scanned continuous glucose monitoring in adults with type 1 diabetes (ALERTT1): a 6-month, prospective, multicentre, randomised controlled trial. Lancet. 2021: 2275 [PMID: 34089660 10.1016/S0140-6736(21)00789-3: 10.1016/S0140-6736(21)00789-3]

11. Varkevisser RDM, Birnie E, Mul D, van Dijk PR, Aanstoot HJ, Wolffenbuttel BHR, van der Klauw MM. Type 1 diabetes management: Room for improvement. J Diabetes. 2023: 255 [PMID: 36808864 10.1111/1753-0407.13368: 10.1111/1753-0407.13368]

12. Zaharieva DP, Messer LH, Paldus B, O'Neal DN, Maahs DM, Riddell MC. Glucose Control During Physical Activity and Exercise Using Closed Loop Technology in Adults and Adolescents with Type 1 Diabetes. Can J Diabetes. 2020: 740 [PMID: 33011134 10.1016/j.jcjd.2020.06.003: 10.1016/j.jcjd.2020.06.003]

13. Pratley RE, Kanapka LG, Rickels MR, Ahmann A, Aleppo G, Beck R, Bhargava A, Bode BW, Carlson A, Chaytor NS, Fox DS, Goland R, Hirsch IB, Kruger D, Kudva YC, Levy C, McGill JB, Peters A, Philipson L, Philis-Tsimikas A, Pop-Busui R, Shah VN, Thompson M, Vendrame F, Verdejo A, Weinstock RS, Young L, Miller KM, Wireless Innovation for Seniors With Diabetes Mellitus Study G. Effect of Continuous Glucose Monitoring on Hypoglycemia in Older Adults With Type 1 Diabetes: A Randomized Clinical Trial. JAMA. 2020: 2397 [PMID: 32543682 10.1001/jama.2020.6928: 10.1001/jama.2020.6928]

14. Galindo RJ, Aleppo G. Continuous glucose monitoring: The achievement of 100 years of innovation in diabetes technology. Diabetes Res Clin Pract. 2020: 108502 [PMID: 33065179 10.1016/j.diabres.2020.108502: 10.1016/j.diabres.2020.108502]

15. Laffel LM, Kanapka LG, Beck RW, Bergamo K, Clements MA, Criego A, DeSalvo DJ, Goland R, Hood K, Liljenquist D, Messer LH, Monzavi R, Mouse TJ, Prahalad P, Sherr J, Simmons JH, Wadwa RP, Weinstock RS, Willi SM, Miller KM, Teens CGMIi, Young Adults with TDSG, Cde. Effect of Continuous Glucose Monitoring on Glycemic Control in Adolescents and Young Adults With Type 1 Diabetes: A Randomized Clinical Trial. JAMA. 2020: 2388 [PMID: 32543683 10.1001/jama.2020.6940: 10.1001/jama.2020.6940]

16. Keyu G, Jiaqi L, Liyin Z, Jianan Y, Li F, Zhiyi D, Qin Z, Xia L, Lin Y, Zhiguang Z. Comparing the effectiveness of continuous subcutaneous insulin infusion with multiple daily insulin injection for patients with type 1 diabetes mellitus evaluated by retrospective continuous glucose monitoring: A real-world data analysis. Front Public Health. 2022: 990281 [PMID: 36091534 10.3389/fpubh.2022.990281: 10.3389/fpubh.2022.990281]

17. McAuley SA, Vogrin S, Lee MH, Paldus B, Trawley S, de Bock MI, Abraham MB, Bach LA, Burt MG, Cohen ND, Colman PG, Davis EA, Hendrieckx C, Holmes-Walker DJ, Jenkins AJ, Kaye J, Keech AC, Kumareswaran K, MacIsaac RJ, McCallum RW, Sims CM, Speight J, Stranks SN, Sundararajan V, Ward GM, Jones TW, O'Neal DN, Australian JC-LRG. Less Nocturnal Hypoglycemia but Equivalent Time in Range Among Adults with Type 1 Diabetes Using Insulin Pumps Versus Multiple Daily Injections. Diabetes Technol Ther. 2021: 460 [PMID: 33351699 10.1089/dia.2020.0589: 10.1089/dia.2020.0589]

18. Huo L, Deng W, Lan L, Li W, Shaw JE, Magliano DJ, Ji L. Real-World Application of Insulin Pump Therapy Among Patients With Type 1 Diabetes in China: A Cross-Sectional Study. Front Endocrinol (Lausanne). 2022: 891718 [PMID: 35757419 10.3389/fendo.2022.891718: 10.3389/fendo.2022.891718]

19. Harper A, Aflatoony L, Wilson W, Wang W, editors. Exploring the Challenges and Potential Alternatives to Insulin Pump Technologies. Proceedings of the 14th EAI International Conference on Pervasive Computing Technologies for Healthcare; 2020.

20. Gu M. Effective Use of Insulin Pump in Patients with Type 1 Diabetes. The Journal of Korean Diabetes. 2020: 36 10.4093/jkd.2020.21.1.36: 10.4093/jkd.2020.21.1.36]

21. DemİR G, ÇUbukcu E, Akcay N. Problems in Insulin Pump Management and Suggestions for Solutions in Children and Adolescents with Type 1 Diabetes. Turkish Journal of Diabetes and Obesity. 2022: 187 10.25048/tudod.1105407: 10.25048/tudod.1105407]

22. O'Donnell HK, Vigers T, Johnson SB, Pyle L, Wright N, Deeb LC, Driscoll KA. Pump It Up! A randomized clinical trial to optimize insulin pump self-management behaviors in adolescents with type 1 diabetes. Contemp Clin Trials. 2021: 106279 [PMID: 33440262 10.1016/j.cct.2021.106279: 10.1016/j.cct.2021.106279]

23. Boscari F, Avogaro A. Current treatment options and challenges in patients with Type 1 diabetes: Pharmacological, technical advances and future perspectives. Rev Endocr Metab Disord. 2021: 217 [PMID: 33755854 10.1007/s11154-021-09635-3: 10.1007/s11154-021-09635-3]

24. Almogbel E. Impact of insulin pump therapy on glycemic control among adult Saudi type-1 diabetic patients. An interview-based case-control study. J Family Med Prim Care. 2020: 1013 [PMID: 32318460 10.4103/jfmpc.jfmpc_869_19: 10.4103/jfmpc.jfmpc_869_19]

25. Biester T, Schwandt A, Heidtmann B, Rami-Merhar B, Haak T, Festa A, Kostow S, Muller A, Monkemoller K, Danne T, Initiative DPV. Declining Frequency of Acute Complications Associated with Tubeless Insulin Pump Use: Data from 2,911 Patients in the German/Austrian Diabetes Patienten Verlaufsdokumentation Registry. Diabetes Technol Ther. 2021: 527 [PMID: 33684335 10.1089/dia.2020.0675: 10.1089/dia.2020.0675]

26. Agarwal S, Schechter C, Gonzalez J, Long JA. Racial-Ethnic Disparities in Diabetes Technology use Among Young Adults with Type 1 Diabetes. Diabetes Technol Ther. 2021: 306 [PMID: 33155826 10.1089/dia.2020.0338: 10.1089/dia.2020.0338]

27. Everett EM, Wright D, Williams A, Divers J, Pihoker C, Liese AD, Bellatorre A, Kahkoska AR, Bell R, Mendoza J, Mayer-Davis E, Wisk LE. A Longitudinal View of Disparities in Insulin Pump Use Among Youth with Type 1 Diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Technol Ther. 2023: 131 [PMID: 36475821 10.1089/dia.2022.0340: 10.1089/dia.2022.0340]

28. Lipman TH, Willi SM, Lai CW, Smith JA, Patil O, Hawkes CP. Insulin Pump Use in Children with Type 1 Diabetes: Over a Decade of Disparities. J Pediatr Nurs. 2020: 110 [PMID: 32889433 10.1016/j.pedn.2020.08.007: 10.1016/j.pedn.2020.08.007]

29. Kanbour S, Jones M, Abusamaan MS, Nass C, Everett E, Wolf RM, Sidhaye A, Mathioudakis N. Racial Disparities in Access and Use of Diabetes Technology Among Adult Patients With Type 1 Diabetes in a U.S. Academic Medical Center. Diabetes Care. 2023: 56 [PMID: 36378855 10.2337/dc22-1055: 10.2337/dc22-1055]

30. Carrillo-Iregui A, Lopez-Mitnik G, Cossio S, Garibay-Nieto N, Arheart KL, Messiah SE. Relationship between aminotransferases levels and components of the metabolic syndrome among multiethnic adolescents. J Pediatr Endocrinol Metab. 2010: 1253 [PMID: 21714459 10.1515/jpem.2010.199: 10.1515/jpem.2010.199]

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2024 ASIDE Internal Medicine