Various socio-demographic characteristics fuel the disparities observed in pediatric diabetes care. At the 81st American Diabetes Association Virtual Science Session, Ananta Addala, DO, MPH, Pediatric Endocrinologist and Medical Scientist at Stanford University in Palo Alto, Calif., Addressed the role of socioeconomic status in these disparities. .
Addala noted that previous research has shown that minority patients often receive poorer quality health care than their peers. The reasons for the differences in care include environmental factors and discrimination. Clinical judgment on the appropriateness of care as well as patient preferences have also been seen as contributing to the difference in the quality of care, but have long been noted as not contributing to the disparities, but Addala believes both do. Along with the management of diabetes, one of the main places where disparities are seen is access to diabetes technologies such as insulin pumps and continuous glucose monitors. Diabetes technology has been shown to improve hemoglobin A1c levels, especially in pediatric cases. Children with low family income as well as public or uninsured insurance have higher hemoglobin A1c levels, indicating less access to diabetes technology.
She then discusses the results of a study comparing insulin pump use and continuous glucose monitoring by socioeconomic status in 2 cohorts: 1 in the United States and Germany, at 2 different times, 2010 -2012 and 2016-2018. The German cohort was selected because it represented an economy similar to that of the United States. In both cohorts, the researchers found an increase in the use of insulin pumps between the 2 periods. However, the American cohort showed that significantly fewer patients from the lowest socioeconomic group used pumps than those from the highest economic group, while in the German cohort, negligible differences were noted between socioeconomic groups. economic. Ongoing blood glucose monitoring saw a significant increase in use for both cohorts, but as with insulin pumps, the US cohort showed significant disparities in use by socioeconomic status. In Germany there was very little difference between them. Therefore, hemoglobin A1c levels are significantly higher in the lowest socioeconomic status level in the United States. Children at the lowest socioeconomic level in Germany also had higher hemoglobin A1c levels than their wealthier peers, but the difference was much less significant.
Insurance may be at the root of these disparities, Addala noted. She discussed a recent comment that showed the variability in the requirements for a child in a Medicaid program to get continuous blood sugar monitoring. Some states like Ohio and Wisconsin do not offer specific requirements for the technology. Others, like Utah and New York State, will only cover the technology for patients with type 1 diabetes who also perform self-administered finger-prick blood sugar tests at least 4 times a day. A final factor of disparities is the prejudices that some providers may have towards patients with lower socioeconomic status. A meta-analysis found that providers often had less empathy for patients from lower socioeconomic groups.
1. Addala A. The state of disparities in the management of pediatric diabetes: the role of socio-economic status. American Diabetes Association Scientific Sessions 2021; June 26, 2021; virtual. Accessed June 26, 2021.