"The pump is one thing… but you should walk out of the hospital with a [sensor]": Perceptions on diabetes technology from minoritized caregivers in the US.

AIMS: Drivers of inequitable health outcomes are underexplored in minoritized youth with type 1 diabetes (T1D). In this pilot qualitative study, we recruited parents and guardians (hereafter referred to as caregivers) of youth with T1D on public insurance at Stanford Medicine Children's Health. We explore the reasons caregivers cited for lower uptake of insulin pumps as compared with continuous glucose monitoring (CGM) sensors.

METHODS

Caregivers (n = 21, 39 ± 8 years, youth age range 3-11 years, 67% Hispanic, 48% Spanish-speaking, 69% income <$50 K) completed focus groups or interviews which were conducted, transcribed, and analysed in English (n = 9) or Spanish (n = 7), per caregiver preference. Transcripts were analysed deductively and inductively by a four-member team that included three bilingual members.

RESULTS

One prevailing and novel theme emerged: CGM is a necessity, but an insulin pump is negotiable, with three supporting sub-themes: (1) child preference (e.g., body real estate); (2) parental hesitancy (e.g., pump mistrust); (3) provider as gatekeeper (e.g., CGM prioritized). The second and third themes identified were insurance-related barriers and language-related barriers (e.g., English manuals only). The final theme identified was facilitators of pump use (e.g., recommendation by provider).

CONCLUSIONS

Caregivers of youth with T1D and public insurance endorse the perception that CGM is a necessity over an insulin pump. Clinicians should be aware of this perception given the overwhelming evidence supporting that automated insulin delivery systems improve diabetes outcomes. These data further outline the importance of continued advocacy by clinicians, payers, and industry for equitable access to diabetes technology for all youth with T1D.