Solutions to Address Inequity in Diabetes Technology Use in Type 1 Diabetes: Results from Multidisciplinary Stakeholder Co-creation Workshops

Abstract

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.

DiabetesWise: An innovative approach to promoting diabetes device awareness

“…Such component may serve to combat the barriers to device prescription and uptake outside of the person seeking a new device and can pave the way for further patient empowerment. DiabetesWise also aligns with Agarwal and colleagues' 29 recommendations to address device disparities: (1) more equitable systems of offering technology, (2) more accessible and approachable technology introduction and education, (3) better inclusion of peer and family supports, and (4) assistance with navigating insurance. The current findings can fuel these efforts: effective and equitable device awareness and education is provided via the personcentered approach of DiabetesWise.…”

The impact of socioeconomic factors, social determinants, and ethnicity on the utilization of glucose sensor technology among persons with diabetes mellitus: a narrative review

“…This program matches the barriers identified via group interviews. 87 In addition, the same study also found a need for enhanced low-literacy and peer-to-peer support. A comparable program was implemented by Mathias et al 88 This program included the formation of specialty clinics, the inclusion of social need-trained practice nurses in that clinic, additional CGM training for the staff, including bias training, and streamlining CGM prescription workflow.…”

Disparities in Hemoglobin A1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

“…These procedures allowed for the minimization, but not elimination, of system-level drivers of interruptions in CGM use. Challenges with troubleshooting faulty CGM supplies, a barrier to sustained CGM use that disproportionality burdens Hispanic youths and youths with public insurance, 45 , 46 , 47 likely influenced CGM utilization. We hypothesize that the lower percentage of CGM wear-time observed among Hispanic youths and youths with public insurance in the Pilot-4T cohort is an artifact of CGM receivers used in these groups.…”