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.
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