Racial/Ethnic Inequities in Use of Diabetes Technologies Among Medicare Advantage Beneficiaries with Type 1 Diabetes
- PMID: 36715293
- DOI: 10.1210/clinem/dgad046
Racial/Ethnic Inequities in Use of Diabetes Technologies Among Medicare Advantage Beneficiaries with Type 1 Diabetes
Abstract
Context: Racial/ethnic inequities have been observed in diabetes care.
Objective: To measure changes in prevalence of continuous glucose monitoring (CGM) and insulin pump therapy among Medicare Advantage (MA) beneficiaries with type 1 diabetes (T1D) by race/ethnicity and to determine the impact of socioeconomic factors on racial/ethnic inequities.
Design: The prevalence of CGM and pump use was assessed by race/ethnicity for MA beneficiaries annually from 2017 - 2020. Models predicting technology use by year, race/ethnicity, age, sex, endocrinology visits, and measures of socioeconomic status (SES) were fit.
Setting: Community.
Patients or other participants: Beneficiaries with T1D and two or more claims with a diabetes diagnosis in the coverage year.
Intervention(s): Insulin pump or CGM therapy.
Main outcome measure(s): Use of diabetes technology by racial/ethnic group.
Results: Technology use increased from 2017-2020 in all racial/ethnic groups. The absolute difference in use between White and Black beneficiaries from 2017 to 2020 remained stable for insulin pumps (10.7% to 10.8%) and increased for CGM (2.6% to 11.1%). The differences in pump use from 2017 to 2020 narrowed between White and Hispanic beneficiaries (12.3% to 11.4%) and White and Asian beneficiaries (9.7% to 6.6%), while the opposite occurred for CGM use (3.0% to 15.5% for White vs. Hispanic beneficiaries; 1.5% to 8.0% for White vs. Asian beneficiaries). Racial/ethnic inequities persisted (p < 0.0001) after adjusting for other characteristics.
Conclusions: Differences in diabetes technology use between racial/ethnic groups often persisted from 2017 through 2020, and could not be explained by demographics, SES, or endocrinology visits.
Keywords: Medicare; Medicare Advantage; continuous glucose monitoring; insulin pump; race/ethnicity; type 1 diabetes.
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