1
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Backholer K, Ebekozien O, Hofman K, Miranda JJ, Seidu S. Health equity in endocrinology. Nat Rev Endocrinol 2024; 20:130-135. [PMID: 37884738 DOI: 10.1038/s41574-023-00912-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia.
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA, USA.
- John D Bower School of Population Health, University of Mississippi, Jackson, MS, USA.
| | - Karen Hofman
- SA MRC/Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - J Jaime Miranda
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Samuel Seidu
- Diabetes Research Centre, Centre for Ethnic Health Research, University of Leicester, Leicester General Hospital, Leicester, UK.
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2
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Maahs DM, Prahalad P, Schweiger DS, Shalitin S. Diabetes Technology and Therapy in the Pediatric Age Group. Diabetes Technol Ther 2024; 26:S117-S140. [PMID: 38441448 DOI: 10.1089/dia.2024.2508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- David M Maahs
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
- Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA
| | - Priya Prahalad
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
| | - Darja Smigoc Schweiger
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Shlomit Shalitin
- Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Ebekozien O, Fantasia K, Farrokhi F, Sabharwal A, Kerr D. Technology and health inequities in diabetes care: How do we widen access to underserved populations and utilize technology to improve outcomes for all? Diabetes Obes Metab 2024; 26 Suppl 1:3-13. [PMID: 38291977 PMCID: PMC11040507 DOI: 10.1111/dom.15470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
Digital health technologies are being utilized increasingly in the modern management of diabetes. These include tools such as continuous glucose monitoring systems, connected blood glucose monitoring devices, hybrid closed-loop systems, smart insulin pens, telehealth, and smartphone applications (apps). Although many of these technologies have a solid evidence base, from the perspective of a person living with diabetes, there remain multiple barriers preventing their optimal use, creating a digital divide. In this article, we describe many of the origins of these barriers and offer recommendations on widening access to digital health technologies for underserved populations living with diabetes to improve their health outcomes.
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Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, Massachusetts, USA
- Department of Population Health, University of Mississippi, Jackson, Mississippi, USA
| | - Kathryn Fantasia
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Farnoosh Farrokhi
- Alta Bates Summit Medical Centre, Sutter East Bay Medical Foundation, Oakland, California, USA
| | - Ashutosh Sabharwal
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas, USA
| | - David Kerr
- Centre for Health System Research, Sutter Health, Santa Barbara, California, USA
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4
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Addala A, Mungmode A, Ospelt E, Sanchez JE, Malik F, Demeterco-Berggren C, Butler A, Edwards C, Manukyan M, Ochoa-Maya M, Zupa M, Ebekozien O. Current Practices in Operationalizing and Addressing Racial Equity in the Provision of Type 1 Diabetes Care: Insights from the Type 1 Diabetes Exchange Quality Improvement Collaborative Health Equity Advancement Lab. Endocr Pract 2024; 30:41-48. [PMID: 37806550 DOI: 10.1016/j.eprac.2023.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Medical racism contributes to adverse health outcomes. Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI) is a large population-based cohort engaged in data sharing and quality improvement to drive system changes in T1D care. The annual T1DX-QI survey included questions to evaluate racial equity in diabetes care and practices to promote equity. METHODS The annual T1DX-QI survey was administered to participating clinics in fall 2022 and had a 93% response rate. There were 50 responses (pediatric: 66% and adult: 34%). Questions, in part, evaluated clinical resources and racial equity. Response data were aggregated, summarized, and stratified by pediatric/adult institutions. RESULTS Only 21% pediatric and 35% adult institutions felt that all their team members can articulate how medical racism contributes to adverse diabetes outcomes. Pediatric institutions reported more strategies to address medical racism than adult (3.6 vs 3.1). Organizational strategies to decrease racial discrimination included employee trainings, equity offices/committees, patient resources, and hiring practices. Patient resources included interpreter services, transportation, insurance navigation, and housing and food assistance. Hiring practices included changing prior protocols, hiring from the community, and diversifying workforces. Most institutions have offered antiracism training in the last year (pediatric: 85% and adult: 72%) and annually (pediatric: 64% and adult: 56%). Pediatric teams felt that their antiracism training was effective more often (pediatric: 60% and adult: 45%) and more commonly, they were provided resources (pediatric: 67% and adult: 47%) to help address inequities. CONCLUSION Despite increased antiracism training, insufficient institutional support and perceived subeffective training still represent obstacles, especially in adult institutions. Sharing effective strategies to address medical racism will help institutions take steps to mitigate inequities.
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Affiliation(s)
- Ananta Addala
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford School of Medicine, California.
| | | | | | - Janine E Sanchez
- Division of Pediatric Endocrinology, University of Miami, Florida
| | - Faisal Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Carla Demeterco-Berggren
- Division of Pediatric Endocrinology, University of California, San Diego, Rady Children's Hospital, San Diego, California
| | - Ashley Butler
- Division of Pediatric Endocrinology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | | | - Makaila Manukyan
- Office of Equity, Vitality, and Inclusion, Boston Medical Center, Boston, Massachusetts
| | | | - Margaret Zupa
- Divison of Endocrinology, University of Pittsburgh Medical Center, Pittsburgh
| | - Osagie Ebekozien
- T1D Exchange, Boston, Massachusetts; Deartment of Population Health, University of Mississippi School of Population Health, Mississippi
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5
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Addala A. Making a Good Thing Even Better: Expanding Access and Applicability of Automated Insulin Delivery Systems to Benefit All Youth With Type 1 Diabetes. Diabetes Care 2023; 46:2126-2128. [PMID: 38011525 DOI: 10.2337/dci23-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Ananta Addala
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA
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6
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Ebekozien O. Roadmap to Achieving Continuous Glucose Monitoring Equity: Insights From the T1D Exchange Quality Improvement Collaborative. Diabetes Spectr 2023; 36:320-326. [PMID: 37982057 PMCID: PMC10654123 DOI: 10.2337/dsi23-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
This article describes successful interventions from the T1D Exchange Quality Improvement Collaborative (T1DX-QI) to reduce inequities in access to and use of continuous glucose monitoring (CGM). The author proposes a roadmap with recommendations for different stakeholders to achieve CGM equity using insights from the T1DX-QI experience.
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Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, MA, and the University of Mississippi School of Population Health, Jackson, MS
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7
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Agarwal S, Majidi S, Rioles N, Ebekozien O. Driving Equity and Innovation in the T1D Exchange Quality Improvement Collaborative: Advancing Outcomes Through Collaborative Change. Clin Diabetes 2023; 42:13-16. [PMID: 38230335 PMCID: PMC10788656 DOI: 10.2337/cd23-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Shivani Agarwal
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | | | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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8
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Ebekozien O, Mungmode A, Sanchez J, Rompicherla S, Demeterco-Berggren C, Weinstock RS, Jacobsen LM, Davis G, McKee A, Akturk HK, Maahs DM, Kamboj MK. Longitudinal Trends in Glycemic Outcomes and Technology Use for Over 48,000 People with Type 1 Diabetes (2016-2022) from the T1D Exchange Quality Improvement Collaborative. Diabetes Technol Ther 2023; 25:765-773. [PMID: 37768677 DOI: 10.1089/dia.2023.0320] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Objective: Previous studies revealed that hemoglobin A1c (HbA1c) increased overall in the United States in the past decade. In addition, health inequities in type 1 diabetes (T1D) outcomes by race/ethnicity and insurance type persist. This study examines the trends in HbA1c from 2016 to 2022 stratified by race/ethnicity and insurance in a large multicenter national database. Research Design and Methods: We analyzed glycemic outcomes and diabetes device use trends for >48,000 people living with type 1 diabetes (PwT1D) from 3 adult and 12 pediatric centers in the T1D Exchange Quality Improvement Collaborative (T1DX-QI), comparing data from 2016 to 2017 with data from 2021 to 2022. Results: The mean HbA1c in 2021-2022 was lower at 8.4% compared with the mean HbA1c in 2016-2017 of 8.7% (0.3% improvement; P < 0.01). Over the same period, the percentage of PwT1D using a continuous glucose monitor (CGM), insulin pump, or hybrid closed-loop system increased (45%, 12%, and 33%, respectively). However, these improvements were not equitably demonstrated across racial/ethnic groups or insurance types. Racial/ethnic and insurance-based inequities persisted over all 7 years across all outcomes; comparing non-Hispanic White and non-Hispanic Black PwT1D, disparate gaps in HbA1c (1.2%-1.6%), CGM (30%), pump (25%-35%), and hybrid-closed loop system (up to 20%) are illuminated. Conclusion: Population-level data on outcomes, including HbA1c, can provide trends and insights into strategies to improve health for PwT1D. The T1DX-QI cohort showed a significant improvement in HbA1c from 2016 to 2022. Improvements in diabetes device use are also demonstrated. However, these increases were inconsistent across all racial/ethnic groups or insurance types, an important focus for future T1D population health improvement work.
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Affiliation(s)
- Osagie Ebekozien
- Office of Chief Medical Officer, T1D Exchange, Boston, Massachusetts, USA
- School of Population Health, University of Mississippi, Jackson, Mississippi, USA
| | - Ann Mungmode
- Office of Chief Medical Officer, T1D Exchange, Boston, Massachusetts, USA
| | - Janine Sanchez
- Department of Endocrinology, Miller School of Medicine, University of Miami, Maimi, Florida, USA
| | - Saketh Rompicherla
- Office of Chief Medical Officer, T1D Exchange, Boston, Massachusetts, USA
| | - Carla Demeterco-Berggren
- Department of Endocrinology, Rady Children's Hospital, San Diego, California, USA
- Department of Endocrinology, University of California, San Francisco, California, USA
| | - Ruth S Weinstock
- Department of Endocrinology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Laura M Jacobsen
- Department of Endocrinology, University of Florida, Gainsville, Florida, USA
| | | | - Alexis McKee
- Department of Endocrinology, Washington University at St Louis, St Louis, USA
| | - Halis K Akturk
- Department of Endocrinology, Barbara Davis Center, Aurora, Colorado, USA
| | - David M Maahs
- Department of Pediatric Endocrinology, Lucile Packard Children's Hospital at Stanford University, Palo Alto, California, USA
| | - Manmohan K Kamboj
- Department of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio, USA
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9
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Gandhi K, Ebekozien O, Noor N, McDonough RJ, Hsieh S, Miyazaki B, Dei-Tutu S, Golden L, Desimone M, Hardison H, Rompicherla S, Akturk HK, Kamboj MK. Insulin Pump Utilization in 2017-2021 for More Than 22,000 Children and Adults With Type 1 Diabetes: A Multicenter Observational Study. Clin Diabetes 2023; 42:56-64. [PMID: 38230341 PMCID: PMC10788665 DOI: 10.2337/cd23-0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
This large type 1 diabetes cohort study showed that insulin pump utilization has increased over time and that use differs by sex, insurance type, and race/ethnicity. Insulin pump use was associated with more optimal A1C, increased use of continuous glucose monitoring (CGM), and lower rates of diabetic ketoacidosis and severe hypoglycemia. People who used an insulin pump with CGM had lower rates of acute events than their counterparts who used an insulin pump without CGM. These findings highlight the need to improve access of diabetes technology through provider engagement, multidisciplinary approaches, and efforts to address health inequities.
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Affiliation(s)
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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Walker AF, Graham S, Maple-Brown L, Egede LE, Campbell JA, Walker RJ, Wade AN, Mbanya JC, Long JA, Yajnik C, Thomas N, Ebekozien O, Odugbesan O, DiMeglio LA, Agarwal S. Interventions to address global inequity in diabetes: international progress. Lancet 2023; 402:250-264. [PMID: 37356448 PMCID: PMC10726974 DOI: 10.1016/s0140-6736(23)00914-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 06/27/2023]
Abstract
Diabetes is a serious chronic disease with high associated burden and disproportionate costs to communities based on socioeconomic, gender, racial, and ethnic status. Addressing the complex challenges of global inequity in diabetes will require intentional efforts to focus on broader social contexts and systems that supersede individual-level interventions. We codify and highlight best practice approaches to achieve equity in diabetes care and outcomes on a global scale. We outline action plans to target diabetes equity on the basis of the recommendations established by The Lancet Commission on Diabetes, organising interventions by their effect on changing the ecosystem, building capacity, or improving the clinical practice environment. We present international examples of how to address diabetes inequity in the real world to show that approaches addressing the individual within a larger social context, in addition to addressing structural inequity, hold the greatest promise for creating sustainable and equitable change that curbs the global diabetes crisis.
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Affiliation(s)
- Ashby F Walker
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Sian Graham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Endocrinology, Royal Darwin and Palmerston Hospitals, Darwin, NT, Australia
| | - Leonard E Egede
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jean Claude Mbanya
- Division of Endocrinology, Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Judith A Long
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA, USA
| | | | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, India
| | | | | | - Linda A DiMeglio
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Department of Endocrinology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; New York Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY, USA.
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11
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Howe CJ, Morone J, Hawkes CP, Lipman TH. Racial Disparities in Technology Use in Children With Type 1 Diabetes: A Qualitative Content Analysis of Parents' Perspectives. Sci Diabetes Self Manag Care 2023; 49:55-64. [PMID: 36609201 DOI: 10.1177/26350106221145323] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of the study was to describe differences in non-Hispanic Black (NHB) and non-Hispanic White (NHW) parents' perceptions of factors that influence the use of diabetes technology. METHODS Focus groups were conducted with parents of NHB and NHW children at a pediatric diabetes center in the Northeast United States. Kilbourne's health disparities framework informed the focus group guide and a priori coding for directed content analysis. Further analysis allowed subcategories to emerge inductively. RESULTS Twenty-one parents participated. Five subcategories emerged, describing differences in NHB and NHW parent decisions regarding diabetes technology: (1) child's choice, (2) shame versus pride, (3) pros and cons of technology, (4) time frame, and (5) blood glucose indications of readiness. NHB parents feared technology malfunction, worried that visible devices could worsen experienced stigma of diabetes diagnosis, and described the diabetes team as gatekeepers, who changed eligibility criteria for diabetes technology use for their research purposes. In contrast, NHW parents reported diabetes team expectation of diabetes technology use and did not report provider-related barriers. CONCLUSION This study adds to existing literature advancing our understanding of the patient and provider mechanisms underlying racial disparities in diabetes technology use. This understanding may guide development of interventions focused on patients, providers, and structural factors to improve equity in use of diabetes technology by youth with type 1 diabetes.
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Affiliation(s)
- Carol J Howe
- Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, Texas
| | - Jennifer Morone
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Colin P Hawkes
- Diabetes Center for Children, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia
| | - Terri H Lipman
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia
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Messer LH, Addala A, Weinzimer SA. Real-World Diabetes Technology: Overcoming Barriers and Disparities. Diabetes Technol Ther 2023; 25:S176-S190. [PMID: 36802191 DOI: 10.1089/dia.2023.2511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Laurel H Messer
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ananta Addala
- Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Stuart A Weinzimer
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
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13
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Majidi S, Rioles N, Agarwal S, Ebekozien O. Evolution of the T1D Exchange Quality Improvement Collaborative (T1DX-QI): Using Real-World Data and Quality Improvement to Advance Diabetes Outcomes. Clin Diabetes 2022; 41:32-34. [PMID: 36714252 PMCID: PMC9845080 DOI: 10.2337/cd22-0074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | | | - Shivani Agarwal
- Albert Einstein College of Medicine–Montefiore Medical Center, Bronx, NY
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14
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Odugbesan O, Addala A, Nelson G, Hopkins R, Cossen K, Schmitt J, Indyk J, Jones NHY, Agarwal S, Rompicherla S, Ebekozien O. Implicit Racial-Ethnic and Insurance-Mediated Bias to Recommending Diabetes Technology: Insights from T1D Exchange Multicenter Pediatric and Adult Diabetes Provider Cohort. Diabetes Technol Ther 2022; 24:619-627. [PMID: 35604789 PMCID: PMC9422789 DOI: 10.1089/dia.2022.0042] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Despite documented benefits of diabetes technology in managing type 1 diabetes, inequities persist in the use of these devices. Provider bias may be a driver of inequities, but the evidence is limited. Therefore, we aimed to examine the role of race/ethnicity and insurance-mediated provider implicit bias in recommending diabetes technology. Method: We recruited 109 adult and pediatric diabetes providers across 7 U.S. endocrinology centers to complete an implicit bias assessment composed of a clinical vignette and ranking exercise. Providers were randomized to receive clinical vignettes with differing insurance and patient names as proxy for Racial-Ethnic identity. Bias was identified if providers: (1) recommended more technology for patients with an English name (Racial-Ethnic bias) or private insurance (insurance bias), or (2) Race/Ethnicity or insurance was ranked high (Racial-Ethnic and insurance bias, respectively) in recommending diabetes technology. Provider characteristics were analyzed using descriptive statistics and multivariate logistic regression. Result: Insurance-mediated implicit bias was common in our cohort (n = 66, 61%). Providers who were identified to have insurance-mediated bias had greater years in practice (5.3 ± 5.3 years vs. 9.3 ± 9 years, P = 0.006). Racial-Ethnic-mediated implicit bias was also observed in our study (n = 37, 34%). Compared with those without Racial-Ethnic bias, providers with Racial-Ethnic bias were more likely to state that they could recognize their own implicit bias (89% vs. 61%, P = 0.001). Conclusion: Provider implicit bias to recommend diabetes technology was observed based on insurance and Race/Ethnicity in our pediatric and adult diabetes provider cohort. These data raise the need to address provider implicit bias in diabetes care.
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Affiliation(s)
- Ori Odugbesan
- T1D Exchange, QI & Population Health Department, Boston, Massachusetts, USA
| | - Ananta Addala
- Stanford University, Division of Pediatric Endocrinology & Diabetes, Lucile Packard Children's Hospital, Stanford, California, USA
| | - Grace Nelson
- Le Bonheur Children's Hospital, Pediatric Endocrinology, Memphis, Tennessee, USA
| | - Rachel Hopkins
- SUNY Upstate Medical Center, Division of Endocrinology and Metabolism, Syracuse, New York, USA
| | - Kristina Cossen
- Children's Healthcare of Atlanta, Division of Pediatric Endocrinology, Atlanta, Georgia, USA
| | - Jessica Schmitt
- The University of Alabama Pediatric Endocrinology and Diabetes at Birmingham Hospital, Birmingham, Alabama, USA
| | - Justin Indyk
- Nationwide Children Hospital, Division of Endocrinology, Columbus, Ohio, USA
| | | | - Shivani Agarwal
- Yeshiva University Albert Einstein College of Medicine, Division of Endocrinology, Bronx, New York, USA
| | - Saketh Rompicherla
- T1D Exchange, QI & Population Health Department, Boston, Massachusetts, USA
| | - Osagie Ebekozien
- T1D Exchange, QI & Population Health Department, Boston, Massachusetts, USA
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15
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Prahalad P, Rioles N, Noor N, Rapaport R, Weinstock RS, Ebekozien O. T1D exchange quality improvement collaborative: Accelerating change through benchmarking and improvement science for people with type 1 diabetes. J Diabetes 2022; 14:83-87. [PMID: 34854232 PMCID: PMC9060055 DOI: 10.1111/1753-0407.13234] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- Priya Prahalad
- Pediatric EndocrinologyStanford UniversityStanfordCaliforniaUSA
| | | | | | - Robert Rapaport
- Mount Sinai Kravis Childrenʼs Hospital, Icahn School of MedicineNew YorkNew YorkUSA
| | | | - Osagie Ebekozien
- T1D ExchangeBostonMassachusettsUSA
- Division of Population HealthUniversity of Mississippi School of Population HealthJacksonMississippiUSA
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16
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Mungmode A, Noor N, Weinstock RS, Izquierdo R, Indyk JA, DeSalvo DJ, Corathers S, Demeterco-Berggen C, Hsieh S, Jacobsen LM, Mekhoubad A, Akturk HK, Wirsch A, Scott ML, Chao LC, Miyazaki B, Malik FS, Ebekozien O, Clements M, Alonso GT. Making Diabetes Electronic Medical Record Data Actionable: Promoting Benchmarking and Population Health Improvement Using the T1D Exchange Quality Improvement Portal. Clin Diabetes 2022; 41:45-55. [PMID: 36714251 PMCID: PMC9845086 DOI: 10.2337/cd22-0072] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article describes how the T1D Exchange Quality Improvement Collaborative leverages an innovative web platform, the QI Portal, to gather and store electronic medical record (EMR) data to promote benchmarking and population health improvement in a type 1 diabetes learning health system. The authors explain the value of the QI Portal, the process for mapping center-level data from EMRs using standardized data specifications, and the QI Portal's unique features for advancing population health.
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Affiliation(s)
- Ann Mungmode
- T1D Exchange, Boston, MA
- Corresponding author: Ann Mungmode,
| | | | | | | | - Justin A. Indyk
- Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH
| | | | - Sarah Corathers
- Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | | | | | | | - Halis Kaan Akturk
- Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | | | | | - Lily C. Chao
- Children’s Hospital Los Angeles, Los Angeles, CA
| | | | - Faisal S. Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
| | - Mark Clements
- Children's Mercy – Kansas City, University of Missouri, Kansas City, MO
| | - G. Todd Alonso
- Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO
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Ebekozien O, Mungmode A, Buckingham D, Greenfield M, Talib R, Steenkamp D, Haw JS, Odugbesan O, Harris M, Mathias P, Dickinson JK, Agarwal S. Achieving Equity in Diabetes Research: Borrowing From the Field of Quality Improvement Using a Practical Framework and Improvement Tools. Diabetes Spectr 2022; 35:304-312. [PMID: 36072814 PMCID: PMC9396719 DOI: 10.2337/dsi22-0002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
There are limited tools to address equity in diabetes research and clinical trials. The T1D Exchange has established a 10-step equity framework to advance equity in diabetes research. Herein, the authors outline this approach and expand on its practical application.
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Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
- Corresponding author: Osagie Ebekozien,
| | | | | | | | | | | | - J. Sonya Haw
- Grady Memorial Hospital, Emory University, Atlanta, GA
| | | | | | - Priyanka Mathias
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | | | - Shivani Agarwal
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
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