Background: Racial–ethnic inequity in type 1 diabetes technology use is well documented and contributes to disparities in glycemic and long-term outcomes. However, solutions to address technology inequity remain sparse and lack stakeholder input. Methods: We employed user-centered design principles to conduct workshop sessions with multidisciplinary panels of stakeholders, building off of our prior study highlighting patient-identified barriers and proposed solutions. Stakeholders were convened to review our prior findings and co-create interventions to increase technology use among underserved populations with type 1 diabetes. Stakeholders included type 1 diabetes patients who had recently onboarded to technology; endocrinology and primary care physicians; nurses; diabetes educators; psychologists; and community health workers. Sessions were recorded and analyzed iteratively by multiple coders for common themes. Results: We convened 7 virtual 2-h workshops for 32 stakeholders from 11 states in the United States. Patients and providers confirmed prior published studies highlighting patient barriers and generated new ideas by co-creating solutions. Common themes of proposed interventions included (1) prioritizing more equitable systems of offering technology, (2) using visual and hands-on approaches to increase accessibility of technology and education, (3) including peer and family support systems more, and (4) assisting with insurance navigation and social needs. Discussion: Our study furthers the field by providing stakeholder-endorsed intervention ideas that propose feasible changes at the patient, provider, and system levels to reduce inequity in diabetes technology use in type 1 diabetes. Multidisciplinary stakeholder engagement in disparities research offers unique insight that is impactful and acceptable to the target population.
Objective: Young adults with T1D of racial/ethnic minority status suffer adverse outcomes compared with White peers. Diabetes-related stigma (DRS) is common and may contribute to poor outcomes in minority YA, but further study is needed. Methods: We recruited non-Hispanic Black and Hispanic YA with T1D from pediatric and adult diabetes centers at Montefiore Medical Center in the Bronx, NY for a qualitative study to explore YA lived experiences with T1D, challenges to diabetes self-management, and healthcare interactions. We conducted semi-structured individual interviews, which were audio-recorded, transcribed, and analyzed for common themes until thematic saturation was achieved. We coded for DRS in YA responses using the Diabetes Stigma Assessment Scale (DSAS), which includes three domains for stigma due to having diabetes: 1) treated differently, 2) blame and judgment, and 3) identity concerns. Results: We included 41 YA participants for analysis (mean age 21 yrs, 68% female, 73% Hispanic, 27% Black, mean HbA1c 10.3%). Seventy-eight percent of participants (n=32) qualified as having at least one experience consistent with DRS. Of those, approximately half of participants had experiences consistent with one domain of DRS, nine participants with two DRS domains, and three participants with all three domains. Each stigma domain (treated differently, blame and judgment, and identity concerns) was represented equally among participants with DRS experiences. Notably, several Black participants mentioned that they experienced race discrimination from healthcare providers related to diabetes self-management and outcomes. Conclusions: In this sample of minority YA with T1D, DRS prevalence was very high and had some race-specific associations. Greater recognition of DRS and its contribution to poor outcomes among YA with T1D belonging to racial/ethnic minority groups is needed. Disclosure G. Crespo-ramos: None. M. Finnan: None. J. S. Gonzalez: None. S. Agarwal: None. Funding National Institutes of Health (K23DK115896)
This article outlines how social and health care determinants can affect young adults with diabetes. The authors provide a detailed description of each determinant’s influence on diabetes self-management and offer solutions to help mitigate these harmful effects.
Background: While it is recognized that underserved YA with T1D experience SDOH that contribute to adverse outcomes, it is unknown how often and what SDOH are most frequently experienced, or whether they interfere with self-management, which limits potential for intervention. Using EMA methods, we explored relationships between daily experience of SDOH and diabetes self-management. Methods: We recruited 61 underserved YA (18-30 yo) with T1D from the Bronx, New York. We prompted EMA surveys via smartphone 3 times daily over a 14-day period. We asked YA how SDOH interfered with self-management twice daily: “Since the last survey, which of the following life factors got in the way of your diabetes care today?”. Answer choices included money, food, housing, transportation, personal safety, mental health, and racial/ethnic or socioeconomic discrimination. Descriptive statistics were used to quantify and report frequency and variation of SDOH related care burden over the 14-day period. Results: Overall, 51 YA completed 778 EMA surveys over the 14-day period (23±4 yo, 65% F, 36% Black, 54% Hispanic, 73% Medicaid-insured, mean HbA1c 8.6%). Thirty-seven YA (73%) endorsed at least one daily SDOH related diabetes care burden, on an average of 22% of days. Mental health problems were reported most frequently (n=23 [62%], 11% of days), followed by transportation problems (n=17 [46%], 6% of days), and financial problems (n=15 (41%), 5% of days). The other SDOH choices accounted for less than 5% of responses. Conclusion: Using EMA to study SDOH in a short timeframe identified significant daily SDOH related diabetes care burdens in underserved YA with T1D. Mental health, transportation, and financial barriers prominently and frequently interfered, while others were described more sporadically albeit still present. SDOH need to be measured in new ways to better understand how and when to intervene to improve outcomes in underserved populations. Disclosure M.Finnan: None. C.Schechter: None. G.Crespo-ramos: None. C.J.Hoogendoorn: None. J.S.Gonzalez: Consultant; Virta Health Corp. S.Agarwal: Advisory Panel; Medtronic, Consultant; Beta Bionics, Inc., Research Support; Abbott Diabetes, Dexcom, Inc. Funding NY-Regional Center for Diabetes Translational Research (5P30DK111022-08); National Institute for Diabetes and Digestive and Kidney Diseases (K23DK115896-05)
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