Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun;24(6):381-389.
doi: 10.1089/dia.2021.0496.

Solutions to Address Inequity in Diabetes Technology Use in Type 1 Diabetes: Results from Multidisciplinary Stakeholder Co-creation Workshops

Shivani Agarwal  1   2 , Gladys Crespo-Ramos  1   3 , Stephanie L Leung  1 , Molly Finnan  1 , Tina Park  4 , Katie McCurdy  4 , Jeffrey S Gonzalez  1   2   3 , Judith A Long  5   6
Affiliations

Solutions to Address Inequity in Diabetes Technology Use in Type 1 Diabetes: Results from Multidisciplinary Stakeholder Co-creation Workshops

Shivani Agarwal et al. Diabetes Technol Ther. 2022 Jun.

Abstract

Background: Racial-ethnic inequity in type 1 diabetes technology use is well documented and contributes to disparities in glycemic and long-term outcomes. However, solutions to address technology inequity remain sparse and lack stakeholder input. Methods: We employed user-centered design principles to conduct workshop sessions with multidisciplinary panels of stakeholders, building off of our prior study highlighting patient-identified barriers and proposed solutions. Stakeholders were convened to review our prior findings and co-create interventions to increase technology use among underserved populations with type 1 diabetes. Stakeholders included type 1 diabetes patients who had recently onboarded to technology; endocrinology and primary care physicians; nurses; diabetes educators; psychologists; and community health workers. Sessions were recorded and analyzed iteratively by multiple coders for common themes. Results: We convened 7 virtual 2-h workshops for 32 stakeholders from 11 states in the United States. Patients and providers confirmed prior published studies highlighting patient barriers and generated new ideas by co-creating solutions. Common themes of proposed interventions included (1) prioritizing more equitable systems of offering technology, (2) using visual and hands-on approaches to increase accessibility of technology and education, (3) including peer and family support systems more, and (4) assisting with insurance navigation and social needs. Discussion: Our study furthers the field by providing stakeholder-endorsed intervention ideas that propose feasible changes at the patient, provider, and system levels to reduce inequity in diabetes technology use in type 1 diabetes. Multidisciplinary stakeholder engagement in disparities research offers unique insight that is impactful and acceptable to the target population.

Keywords: Diabetes technology; Disparities; Inequity; Minority; Race–ethnicity; Type 1 diabetes.

PubMed Disclaimer

Conflict of interest statement

S.A. is a health disparities advisor to Medtronic Inc. and Beta Bionics Inc. The other authors have nothing to disclose.

Figures

FIG. 1.
FIG. 1.
Sample workshop slides demonstrating user-centered design principles: empathizing, defining, ideating, and prototyping/co-creation. T1D, type 1 diabetes; YA, young adults.
FIG. 2.
FIG. 2.
Key elements of a diabetes technology equity intervention discussed by multidisciplinary stakeholders. CHW, Community Health Worker.
FIG. 3.
FIG. 3.
Program principles of interventions to increase diabetes technology use in underserved populations with type 1 diabetes.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Agarwal S, Kanapka LG, Raymond JK, et al. : Racial-ethnic inequity in young adults with type 1 diabetes. J Clin Endocrinol Metab 2020;105:e2960–e2969. - PMC - PubMed
    1. Livingstone SJ, Levin D, Looker HC, et al. : Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008–2010. JAMA 2015;313:37–44. - PMC - PubMed
    1. Saydah S, Imperatore G, Cheng Y, et al. : Disparities in diabetes deaths among children and adolescents—United States, 2000–2014. MMWR Morb Mortal Wkly Rep 2017;66:502–505. - PMC - PubMed
    1. Chamberlain JJ, Dopita D, Gilgen E, Neuman A: Impact of frequent and persistent use of continuous glucose monitoring (CGM) on hypoglycemia fear, frequency of emergency medical treatment, and SMBG frequency after one year. J Diabetes Sci Technol. Published online 2015;10:383–388. - PMC - PubMed
    1. Gilbert T, Noar A, Blalock O, Polonsky W: Change in HbA1c and quality of life with real-time CGM use by people with insulin-treated diabetes in the landmark study. Diabetes Technol Ther 2021;23:S35–S39. - PMC - PubMed

Publication types