Context
Health inequity is often associated with race-ethnicity.
Objective
To determine the prevalence of insulin pump therapy and continuous glucose monitoring (CGM) among Medicare beneficiaries with Type 1 diabetes (T1D) by race-ethnicity, and to compare diabetes-related technology users to non-users.
Design
The prevalence of technology use (pump, CGM) was determined by race-ethnicity for enrollees in coverage years (CY) 2017-2019 in the Medicare fee-for-service database. Using CY2019 data, technology users were compared to non-users by race-ethnicity, sex, average age, Medicare eligibility criteria, and visit to an endocrinologist.
Setting
Community
Patients or Other Participants
Beneficiaries with T1D and at least one inpatient or two outpatient claims in a CY
Intervention(s)
Pump or CGM therapy, visit to an endocrinologist
Main Outcome Measure(s)
Diabetes-related technology use by race-ethnicity groups
Results
Between 2017 and 2019 CGM and insulin pump use increased among all groups. Prevalence of insulin pump use was <5% for Black and Other beneficiaries yet increased from 14% to 18% among White beneficiaries. In CY2019 57% of White patients used a pump compared to 33.1% of Black and 30.3% of Other patients (P<0.001). Black patients were more likely than White patients to be eligible due to disability/end-stage renal disease or to be Medicare/Medicaid eligible (both P<0.001), whether using technology or not. Significant race-ethnicity differences (P<0.001) existed between technology users and non-users for all evaluated factors except visiting an endocrinologist.
Conclusions
Significant race-ethnicity associated differences existed in T1D management. The gap in diabetic technology adoption between Black and White beneficiaries grew between 2017 and 2019.