Access to technology is nowadays essential to provide a state-of-the-art care of type 1 diabetes. Different studies have provided evidence that the use of pump and sensors is effective and safe to accomplish glycemic control goals; however, access to technology depends on the reimbursement policies which are very variable among the different countries in the European Union.
For pumps, several studies have shown a gradient north-south in the use of insulin pumps, strongly correlated to reimbursement and % GDP investment in health. For sensors, there are inequalities in the type and grade of reimbursement within different countries across the European Union and sometimes in different areas of the same country. Although, there is clear evidence that socioeconomic factors are very closely linked with the accomplishment of glycemic goals, data regarding performance of diabetes in minorities are really lacking in European populations. In addition, the cultural and linguistical diversity of Europe, makes difficult to establish an accurate and broadly accepted definition of the term minority, which varies among the different countries.
Although it may seem that equity in the access to diabetes technology in Europe is guaranteed no matter if the individual belongs or not to an ethnic minority, the truth is that accessibility to diabetes education is inextricably linked with the ability to speak the native language of a certain country and the adoption of the country native culture. Regarding pediatric care, many young children belonging to ethnic minorities are able to speak fluidly the official languages of the country where they live, but their relatives are not always in the same situation and disbalances in the access to information and education compromises the capacity to choose and learn how to use the technology.
The refugee movement that Europe has been witnessing during the last few years is testing the ability of Europe to provide equality and equity access to technological diabetes therapies.
There are multiple unmet needs in the use of technology in diabetes management worldwide but these are more pronounced in low-resource regions. Cost comes at the top of the list when access to diabetes technologies with expensive devices and supplies is concerned. However, cost is not the sole factor. Roles and regulations over the use of technology can hinder its wide use in countries where electronic security is limited. Digital security and vulnerability might render patients’ safe use of devices at risk as device setting can be accessed remotely and wirelessly changed. Limited accessibility, whether provided in publicly funded health system or based on private insurance poses a major challenge. In addition, shortage of trained health professionals and lack of resources in health sector constitute major factors for the unavailability and the low quality of care and service received for people with diabetes.
Technology use in individuals with type 1 diabetes is associated with improved clinical outcomes. However, access to technology is not available to all populations across North and South America. In this presentation, access to technology in North and South America will be reviewed with emphasis on the access to these devices by individuals from minority groups and lower socioeconomic status.
The literature was reviewed to describe access to technology across various regions of North and South America.
Access to technology is varied across North and South America. Limiting factors for technology access include device availability, device cost, and insurance coverage. Access to technology is even more limited in minority individuals and those with lower socioeconomic status – both groups with worse health outcomes.
Technology is becoming increasingly more important for the management of type 1 diabetes, particularly with the advent of automated insulin delivery devices. Unfortunately, access to technology is variable across North and South America. The most vulnerable populations, individuals of minority status and lower socioeconomic access, have the most restrictive access to technology resulting in a further gap in health disparities. Advocating for equal access to diabetes technology has the potential to narrow care gaps.