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- Title
Inequity in Adoption of Advanced Diabetes Technologies Among Medicare Fee-for-service Beneficiaries.
- Authors
Wherry, Kael; Cyrus Zhu; Vigersky, Robert A.
- Abstract
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 with nonusers. 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 with nonusers 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 1 inpatient or 2 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 with 33.1% of Black and 30.3% of Other patients (P < 0.001). Black patients were more likely than White patients to be eligible because of 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 nonusers 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.
- Subjects
MEDICARE; BENEFICIARIES; HEALTH equity
- Publication
Journal of Clinical Endocrinology & Metabolism, 2022, Vol 107, Issue 5, pe2177
- ISSN
0021-972X
- Publication type
Article
- DOI
10.1210/clinem/dgab869