Disparities in Utilization and Outcomes With Continuous Subcutaneous Insulin Infusion in Young Adults With Type 1 Diabetes

Alexis M. McKee, Noor Al-Hammadi, Leslie J. Hinyard

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: To evaluate which factors determine utilization patterns and outcomes of continuous subcutaneous insulin infusion (CSII) in young adults with type 1 diabetes. Methods: Utilizing the Optum deidentified electronic health record data set between 2008 to 2018 to perform a retrospective cohort study, we identified 2104 subjects with type 1 diabetes aged 18 to 30 years. We evaluated the effect of race on determining CSII utilization, HbA1c (%), and hospital admission for diabetic ketoacidosis (DKA). Crude and adjusted estimates were computed using logistic regression and linear mixed models. Results: There was low CSII utilization among individuals who were Black, Hispanic, male, and those with governmental insurance. These groups also demonstrated higher HbA1c levels. Subjects who were Black, Hispanic, and those with governmental insurance had higher odds of DKA. Even when commercially insured, Black and Hispanic subjects demonstrated higher HbA1c levels, and Black individuals had higher odds of DKA. Conclusion: In a large electronic health record database in the U.S., there was low CSII utilization overall, particularly in Black and Hispanic minorities, despite CSII showing superior HbA1c control without an increase in DKA events.

Original languageEnglish
Pages (from-to)769-775
Number of pages7
JournalEndocrine Practice
Volume27
Issue number8
DOIs
StatePublished - Aug 2021

Keywords

  • continuous subcutaneous insulin infusion
  • diabetes technology
  • disparities
  • type 1 diabetes

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