Presenter of 2 Presentations
INEQUITIES IN DIABETES DEVICE USE: T1D EXCHANGE BASELINE TREND ANALYSIS
Abstract
Background and Aims
Multiple cross-sectional studies have demonstrated lower use of Continuous Glucose Monitors (CGM) in Non-Hispanic Black (NHB) and Hispanic patients with Type 1 diabetes(T1D). This study is a multicenter trend analysis of ethnic and racial disparities in CGM use
Methods
The T1D Exchange Quality Improvement Collaborative (T1Dx-QI) identified four endocrinology centers from the learning network to pilot an equity-focused Quality Improvement study to address disparities in CGM use amongst NHB and Hispanic compared to Non-Hispanic White (NHW) patients. Retrospective aggregate data from the Electronic Medical Record was reported monthly to the coordinating center. The data were stratified by race and ethnicity. Median values were calculated using Lahey P run charts between Nov 2020 and June 2021. Data were analyzed and plotted on a trend chart
Results
The baseline data from participating clinics show a stable trend (p-value<0.001). The median CGM use was 58% amongst NHW patients, 49% among NHB patients, and 48% among Hispanic patients. The difference in the median between NHW and NHB patients is 9% and the difference between NHW and Hispanic patients is 10%
Conclusions
Baseline analysis of the participating sites in CGM use demonstrates fixed and persistent inequity in CGM use between NHW, NHB, and Hispanic patients. The inequities trend is projected to continue except systemic changes are employed. The T1Dx-QI developed a QI Equity Framework and she is using this with the participating centers to develop and scale interventions that address disparities for Non-Hispanic Black and Hispanic patients with T1D.
DIABETES PROVIDER BIAS TO RECOMMENDING DIABETES TECHNOLOGY FOR PATIENTS ON PUBLIC INSURANCE IN THE UNITED STATES
Abstract
Background and Aims
Despite documented benefits of Continuous Glucose Monitors and insulin pumps in managing type 1 diabetes, inequities in the use of devices persist with lower use among Non-Hispanic Blacks and Hispanic patients compared to Non-Hispanic White patients. We aimed to examine the role of insurance mediated provider implicit bias in recommending diabetes technology
Methods
One hundred and nine adult and pediatric diabetes providers across seven US endocrinology centers completed an implicit bias assessment using a revised D-PIB tool. Providers were randomized and assigned case vignettes with different insurance statuses and patient names to proxy racial identity. Bias was tagged as providers recommending more technology for patients with private insurance or ranking insurance as one of the top 3 factors considered in recommending diabetes technology. Analysis was done using descriptive statistics and multivariate logistic regression.
Results
Implicit bias against public insurance was common (n=66, 61%). When compared to those who had a bias, providers who did not have bias had fewer practice years (5.3±5.3 years vs 9.3±9 years, p=0.006). The difference in mean age between the group with bias (42.2±11 years) versus the group without bias (38.3±9.3 years) trended towards significance, p=0.05. The provider's sex, race/ethnicity, personal diagnosis of T1D, roles, workplace characteristics, or perception of bias did not differ in the groups
Conclusions
Insurance mediated implicit bias was observed in our cohort. Addressing implicit bias will involve an approach rooted in racial justice, economic equity, and equitable access to health care and education. Public insurers need to increase equitable coverage to reduce inequities