Introduction and Objective: Inequity in access to diabetes technology such as continuous glucose monitors (CGM) and automated insulin delivery systems (AID) leads to lower adoption in minority and low-income groups. In our urban academic health system, some sites integrate all payors while others have separate clinics for private versus public insurance. We aim to compare tech use between these two models and track responses to quality improvement interventions.Methods: We reviewed EHR data from July 2023-2024 and identified barriers with provider surveys and patient interviews. We implemented four QI cycles using Plan, Do, Study, Act focusing on endocrine fellows, certified diabetes care educator specialists (CDCES), patients, and preceptors including shared prescriber resources, lectures, patient-friendly handouts, CDCES referrals for tech conversations, preceptor flags for tech use, and automated outreach to non-tech users.Results: Baseline data showed tech use was higher at the combined site for all payors (CGM 87% v 74%; AID 58% v 46%), with more inequity between payors at the split site (split AID Medicaid 41% v commercial 55%; combined Medicaid 61% v commercial 64%). Odds of CGM were significantly lower for Black race (OR 0.5), Medicaid (OR 0.38), and Medicare (OR 0.42); for AID lower for Black race (OR 0.45), Medicaid (OR 0.58), and age >65 (OR 0.38). Odds of A1C >8 were significantly higher with Black race (OR 1.6) and Medicaid (OR 2.2) and lower with White race (OR 0.39), CGM (OR 0.42), and AID (OR 0.54). Barriers included low provider comfort in prescribing tech, short visits, and variable continuity. After QI interventions, fellow prescribing comfort and CDCES referrals increased, with patient education materials driving prescribing conversations.Conclusion: Tech usage differed between sites, most notably for patients with public insurance. After identifying barriers to usage, we have implemented interventions to address bias and education with uptake in CDCES referrals and prescribing patterns.
S. Gondi: None. P.E. Dixon: None. M. Rouviere: None. C. Levister: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. N. Shah: None. C.J. Levy: Research Support; Tandem Diabetes Care, Inc. Advisory Panel; Tandem Diabetes Care, Inc. Research Support; MannKind Corporation, Dexcom, Inc., Novo Nordisk, Eli Lilly and Company. G. O’Malley: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc, Novo Nordisk, MannKind Corporation.
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