Abstract Body

Diabetes technology has improved quality of life, increased time-in-range, and decreased hypoglycemia over the past decade. Healthcare in the US is inequitable, including care for people with diabetes. Recent data on disparities in diabetes technology use and outcomes will be reviewed. Local and national efforts to improve access to diabetes technology and to improve outcomes with the goal or reducing socioeconomic disparities will be described.

We would like to thank the other members of the 4T Study Group for their help with this project. Study team members include: Brianna Leverenz, BS, Julie Hooper MPH, RD, Ana Cortes, BS, Franziska Bishop, MS, CDCES, Natalie Pageler, MD, Jeannine Leverenz, RN, CDCES, Piper Sagan, RN, CDCES, Anjoli Martinez-Singh, RD, CDCES, Barry Conrad RD, CDCES, Annette Chmielewski, RD, CDCES, Julie Senaldi RN, CDCES, Nora Arrizon-Ruiz, Erica Pang, BS, Carolyn Herrera, BS, Victoria Ding, MS, Rebecca Gardner, MS, Kim Clash, NP, Erin Hodgson, RD, CDCES, Johannes Ferstad BS, Ryan Pie, MS, Michael Gao, BS, Annie Chang, BS, Simrat Ghuman, PhD, Priya Prahalad MD, Ananta Addala MD, Dessi Zaharieva PhD, Korey Hood PhD, Manisha Desai PhD, Ramesh Johari PhD, David Scheinker PhD and Esli Osmanlliu, MD

Abstract Body

Efficacy and safety of diabetes technology improve continuously. As a consequence, established technologies, like insulin pumps and continuous glucose monitoring systems (CGM), now benefit from improved reimbursement that facilitates their wider use in high-income countries. Nevertheless, ethnic and socioeconomic disparities continue to be reported.

Based on the DPV registry, the use of CGM in patients aged under 26 years increased from 5% in 2009 to 76% in 2021 and the use of insulin pump increased from 32% to 58% in the same period in Germany. Despite increasing use, disparities based on patient’s characteristics persist.

In 2021, the use of insulin pumps was still significantly higher in girls than in boys (61% in girls vs. 55% in boys, P<0.001), whereas the gender difference for the use of CGM remained negligible (77% in girls vs. 76% in boys, P= 0.02). The gender difference in pump use has been observed above age 10 years and increased with age. Poorer metabolic control, variable insulin requirement during the menstrual cycle, and possibility of pregnancy, are factors that contribute to the higher use of insulin pump in female adolescents and young adults compared to males of the same age. Regional disparities in the use of diabetes technology also persist in Germany. Whereas the use of insulin pumps was still associated with area deprivation until 2019, the association with CGM use disappeared in the last years. Nevertheless, in 2021, both technologies were still more frequently used in the former Western Germany, compared to the Eastern part of the country (Pump: 55 vs. 52%, CGM: 76 vs. 71%, both p< 0.001). Independent of area deprivation, the effect of migration background on CGM use decreased over the last years in Germany. However, patients without migration background still use both insulin pump and CGM more frequently. In 2019, 58% of the patients up to age 26 years without migration background used an insulin pump compared to 52% of the second-generation migrants (at least one parent born outside Germany) and 38% of the first-generation migrants (patient himself born outside Germany). Similarly, 77% of the patients without migration background used a CGM, compared to 68 and 60% for the second and first-generation migrants, respectively. Besides complex discriminatory reasons which cannot be excluded, language and cultural barriers may limit the access to diabetes technology.

To conclude, our findings raise the concern that inequitable access to diabetes technology in Germany continues to systematically disadvantage some patients, on the basis of their gender, migration history or socioeconomic situation.

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SOCIOECONOMIC BARRIERS & DISPARITIES IN DIABETES TECHNOLOGY : EXPERIENCE IN INDIA

DR.V. MOHAN, M.D., FRCP (London, Edinburgh, Glasgow & Ireland), Ph.D., D.Sc.

D.Sc (Hon. Causa), FNASc, FASc, FNA, FACE, FACP, FTWAS, MACP, FRSE

Chairman & Chief of Diabetology,

Dr. Mohan’s Diabetes Specialities Centre & Madras Diabetes Research Foundation,

Chennai, India

Email : drmohans@diabetes.ind.in, Websites : www.mdrf.in & www.drmohans.com

The number of people with diabetes globally, is rising at an alarming rate. South Asia is one of the hot spots of the diabetes epidemic. In India alone, there are over 74 million people with diabetes today. Unfortunately, 70% of the doctors in India practice in urban areas while 70% of India’s population lives in rural areas. This mismatch between the availability of health care professionals and the rapid spread of diabetes in rural areas, provides an opportunity to use technology to deliver the diabetes care to remote rural areas.

The first part of this presentation will talk about a model of successful delivery of diabetes health care in rural India. The Chunampet Rural Diabetes Program was carried out in a group of 42 villages in Kancheepuram District in Tamilnadu. Using a Mobile van, a population of 27,014 individuals (86.5% of the adult population) were screened for diabetes. All those detected with diabetes were offered a follow up care at a rural diabetes centre which was set up during the project. The results were very impressive and led to good improvement in A1c levels using low cost generic drugs.

The second use of technology was during the COVID – 19 pandemic and the lock down which was enforced in India. Thankfully, Telemedicine was also legalized in India at that time. Using technology, a system was created whereby the doctor and the patient stayed at home but blood tests were arranged at home for the patient. With the results, teleconsultation was done by doctors using the Electronic Medical Records which were made available on their mobile phones. Thus, despite the lockdown, patients managed to get their tests and diabetes consultations done remotely.

The third use of technology which will be presented is through our network of diabetes clinics across India. Even at centres where there was no ophthalmologist, retinal photographs were obtained using a low-cost retinal camera and were uploaded for centralized diabetic retinopathy grading unit where the images were read by trained retina specialists. The eye reports were sent back to the peripheral clinics in real time. Over one year period, 25,316 individuals with diabetes could have their eyes screened for diabetic retinopathy. Only 11.4 % needed referral to an ophthalmologist for further management.

In conclusion, judicious use of technology can help to bridge the socioeconomic and geographical challenges in delivering diabetes health care in developing countries.