Targeting Technology in Underserved Adults with Type 1 Diabetes: Effect of Diabetes Practice Transformations on Improving Equity in CGM Prescribing Behaviors

Background: Continuous glucose monitoring (CGM) use is associated with improved outcomes in type 1 diabetes, but racial-ethnic disparities exist. Traditional healthcare models perpetuate inequities in CGM prescribing for underserved populations, and effect downstream use. We examined whether we could improve CGM prescribing behaviors by transforming our diabetes practice in an underserved area of New York. 

Research Design and Methods: From January 2019 to December 2021, we initiated several non-grant funded practice transformations targeted toward equity, including development of a type 1 diabetes clinic; training of support staff to place trial CGMs at the point of care; improving prescription workflows; and educating providers on CGM. We included multi-level stakeholders in these changes to improve feasibility, acceptability, and sustainability. To examine effect, we collected monthly aggregate data from the electronic medical record and performed linear regression to examine change in CGM prescriptions over the three years of transformation. 

Results: In total, we included 1, 357 adults with type 1 diabetes [mean age 38 years (±18), 30% Black (n=406), 45% Hispanic (n=612), 12% White (n=164); and 74% publicly insured (n=1004)]. CGM prescription rates increased overall from 15% to 69% (p<0.001). Improvements were seen equally among Black (12 to 72%), Hispanic (15 to 74%), and White adults (20 to 48%) (between-group p=0.053). 

Conclusion: Diabetes practice transformations can have powerful effects on provider prescribing behaviors to reduce root causes of inequity in CGM among underserved adults with type 1 diabetes. Continued focus is needed on upstream interventions that affect downstream determinants of CGM use.