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15-Year Trend Persists in Disparate Insulin Pump Use in Children

Insulin pumps are widely used in the management of type 1 diabetes (T1D) and reviews have shown insulin pump therapy to be associated with improved glycemic control, fewer severe hypoglycemia events, and improved quality of life. Yet, non-Hispanic white children (NHW) are more than twice as likely as non-Hispanic Black children (NHB) to use this technology.

In an article in the Journal of Pediatric Nursing, researchers outline their study findings which have determined that this gap has persisted for 15 years. They consider that this inequity among children with T1D may not be simply attributable to socioeconomic status. They also believe it plays a role in the racial disparities in clinical outcomes seen in type 1 diabetes as NHB children have worse glycemic control and higher rates of complications of the disease.

“This study demonstrates a remarkable lack of progress in addressing racial and ethnic disparities in the area of T1D over the past decade. The extent of these disparities must be fully investigated through research with parents of children with diabetes, and with providers, to determine the contributing factors — including the impact of implicit bias and structural racism,” writes Terri H. Lipman, PhD, CRNP, FAAN, the Miriam Stirl Endowed Term Professor of Nutrition, Professor of Nursing of Children and Assistant Dean for Community Engagement at the University of Pennsylvania School of Nursing (Penn Nursing).

The researchers suggest that increasing diversity in the health care workforce or adding community health workers to the team may play an important role in overcoming these barriers to equitable care. “Interventions must be developed to address these disparities so that optimal diabetes care can be provided to children of all racial, ethnic, and socioeconomic backgrounds,” writes Lipman.

The article, “Insulin Pump Use in Children With Type 1 Diabetes: Over a Decade of Disparities” is available online. Coauthors of the article include Steven M. Willi, Charlene W. Lai, Jennifer A. Smith, Oona Patil, and Colin P. Hawkes, all of the Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia.