Disparities in diabetes technology use among Spanish-speaking children with type 1 diabetes compared to non-Hispanic white peers (Preprint)

BACKGROUND Prior work has revealed racial disparities in both type 1 diabetes (T1D) outcomes and in rates of technology use among Hispanic children compared to non-Hispanic white (NHW) children. OBJECTIVE We aimed to investigate use of insulin pumps and continuous glucose monitoring (CGM) devices among Spanish-speaking children in our clinic population and to identify specific barriers to technology use. METHODS First, we assessed rates and patterns of diabetes technology use (insulin pumps and CGM devices) in a sample of 76 children (38 Spanish-speaking and 38 NHW). We compared rates of technology use, average length of time between diabetes diagnosis and initiation of insulin pump and/or CGM device, and rates of discontinuation of these devices between the Spanish-speaking and NHW children. Second, to understand specific barriers to technology use, we compared responses to a questionnaire assessing decision-making about insulin pumps. RESULTS Spanish-speaking patients had lower rates of insulin pump use, even after controlling for age, gender, age at diagnosis and type of health insurance. Spanish-speaking participants were more likely to report concerns over learning to use an insulin pump, questions about how it works, and concerns about keeping it attached. Furthermore, the Spanish-speaking children were more likely to discontinue insulin pumps after starting them. CONCLUSIONS These data confirm ethnic disparities in insulin pump use among children with T1D and provide new insights about insulin pump discontinuation among Spanish-speaking children. Our findings suggest a need for improved patient education about insulin pump technology in general, and improved support for Spanish-speaking families with T1D after initiation of pump therapy.