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. 2023 Jan 30;dgad046.
doi: 10.1210/clinem/dgad046. Online ahead of print.

Racial/Ethnic Inequities in Use of Diabetes Technologies Among Medicare Advantage Beneficiaries with Type 1 Diabetes

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Racial/Ethnic Inequities in Use of Diabetes Technologies Among Medicare Advantage Beneficiaries with Type 1 Diabetes

Mallika Kommareddi et al. J Clin Endocrinol Metab. .

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.