Intervention boosts connected insulin pen adoption among minorities with Type 1 diabetes

The use of automated insulin injections and continuous glucose monitoring is associated with improved glycemic outcomes in minority adults with Type 1 diabetes, according to a recent study published in Diabetes, Obesity and CardioMetabolic Care.

“Our data, obtained from a largely minority population in which White Hispanic and Black people represent ∼70% of people with Type 1 diabetes attending our clinic, show that A1C levels did not differ substantially between White Hispanic and White non-Hispanic people,” researchers wrote. “However, A1C levels were higher in Black participants compared with White non-Hispanic participants. This finding is consistent with prior evidence indicating that A1C levels may be higher in Black people than in White people, even when glucose levels are similar.”

Researchers, led by Maria A. Yanez Bello, M.D., in the department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, wanted to assess barriers to the adoption of technologies that could help patients better manage their disease. They conducted a survey of 284 adults with Type 1 diabetes at the university’s clinic. The survey was adapted from one previously used to collect data on demographics and the type of technology patients used. Information was gathered on the use of technologies, including multiple daily injections; daily injections along with the use of continuous glucose monitoring (CGM); insulin pumps; insulin pumps with CGM; connected insulin pens (CIP); and CIP with CGM.

Additionally, researchers began an invention program that aimed to increase the use of connected insulin pens among patients that used continuous glucose monitoring along with multiple daily injections who were not using an insulin pump. The primary outcome was the proportion of participants who successfully obtained and initiated CIP use after completing training.

In the analysis, 211 patients who self-identified as White non-Hispanic, White Hispanic, or Black with Type 1 diabetes were included. The cohort included 28.4% White non-Hispanic, 58.8% White Hispanic, 11.8% Black, and 0.9% that were unknown. The mean age was 41.1 years.

Researchers found that technology use was similar across groups. Hemoglobin A1c was lower among those using insulin pump therapy with continuous glucose monitoring than among those using multiple daily insulin injections with continuous glucose monitoring.

Overall, 91.0% of participants used continuous glucose monitoring, 59.7% used insulin pumps with CGM, 8.1% used connected insulin pens, and 5.7% used connected insulin pens along with CGM. Patients using the insulin pens with CGM represented 18.2% of CGM users.

A1C levels were significantly lower in White non-Hispanic compared with Black patients, despite comparable overall diabetes technology use across groups. Researchers found that there were differences in access to private insurance among the patient groups. Additionally, lower A1C was seen among patients who used insulin pumps/CGM compared with those who were doing daily injections along with CGM.

In the survey, patients who used insulin pumps with CGM reported significantly fewer barriers overall compared with those who did daily injections and CGM. The most frequently reported barriers included insurance coverage, cost of supplies, and device cost.

Some patients across White non-Hispanic, White Hispanic, and Black groups who used glucose monitoring expressed concern that the device might not work. Additionally, more of these patients reported difficulty in understanding device data. Lack of family support was also reported more frequently by White Hispanic adults who use CGM compared with pump/CGM users.

They also found that after the intervention, use of connected insulin pens in addition to continuous glucose monitoring increased from 18% to 27%. “Increasing adoption of diabetes technology among minority adults with type 1 diabetes remains necessary, even where continuous glucose monitoring use is high,” researchers wrote.