Inequity in Adoption of Advanced Diabetes Technologies Among Medicare Fee-for-service Beneficiaries

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.

Keywords: Medicare; continuous glucose monitoring; insulin pump; race-ethnicity; type 1 diabetes.