Does the OP5 Automated Insulin Delivery System Close the Gap in Glycemic Control Between White and Black Youth with Type 1 Diabetes?

Abstract

Background: Use of automated insulin delivery (AID) systems improves glycemic control, however, racial and ethnic disparities in glycemic control among youth with type 1 diabetes (T1D) persist. We studied whether the Omnipod 5 (OP5) AID system could close gaps in glycemia between White and Black youth with T1D. Methods: This retrospective longitudinal analysis compared matched pairs of White and Black youth with T1D using OP5 at two pediatric academic centers. In unadjusted and adjusted models, we assessed changes in the gap in time in range (TIR), average continuous glucose monitor (CGM) glucose, and hemoglobin A1c (HbA1c) between White and Black youth from baseline to 9 days and 90 days. Results: Matched pairs (n = 132) of White and Black youth using OP5 (61% female, mean age 11.6 years, 40% publicly insured, median T1D duration 2.9 years, mean HbA1c 8.6%) were included. Within 9 days of OP5 use, the baseline TIR gap of 7.8% points decreased to 3.9% points (P = 0.052), and the average CGM glucose gap of 20.5mg/dL at baseline decreased to 8.0 mg/dL (P = 0.012), demonstrating a reduction in the gap between groups. At 90 days, there was no significant reduction in gap from baseline for TIR (P = 0.35) or CGM glucose (P = 0.09). When adjusting for insurance and baseline insulin delivery method, there was no significant reduction in gaps at either 9 days or 90 days. All youth had decreases in HbA1c. At 90 days, time in automated mode (88% vs. 94%, P < 0.0001) and boluses per day (3.9 vs. 5.3, P < 0.0001) were lower in Black youth. In multivariable analysis, youth transitioning to OP5 from multiple daily injections had the greatest increases in TIR at 9 days (P < 0.001) and at 90 days (P < 0.01). Conclusions: Gaps in TIR and average CGM glucose between White and Black youth narrow with AID use, but do not close completely. Equitable access to AID should be encouraged for all youth, however, differences in AID interaction emphasize the need for additional interventions to overcome social determinants of health that likely explain the inability of diabetes technology to fully close the gaps.

Keywords: automated insulin delivery; barriers; glycemic control; inequities; minority youth; type 1 diabetes.