Scott, M L, Nelson, G, Cossen, K, Odugbesan, O, Mungmode, A, Ebekozien, O, Kamboj, M

Introduction: This work is done on behalf of the T1D Exchange QI Collaborative.

Objectives: Multiple studies have shown HbA1c and insulin pump use are significantly different in patients with type 1 diabetes (T1D), between racial and ethnic groups, with lower A1c and higher insulin pump use noted in non-Hispanic whites compared to Non-Hispanic Black patients (NHB) and Hispanics. We aimed to identify the barriers to the uptake of insulin pumps among NHB and Hispanics with type 1 diabetes.

Methods: The T1D Exchange Quality Improvement Collaborative (T1DX-QI) identified six endocrinology centers to pilot an equity-focused Quality Improvement mixed-method study to address disparities in insulin pump use among NHB and Hispanic patients. Participating sites used process maps and the Ishikawa diagram to identify pain points and barriers in the processes. Barriers were categorized into tiers based on the frequency of occurrence among participating centers.

Results: All participating centers (100%) reported tier 1 barriers as contributors to inequities. A majority of participating centers identified tier 2 barriers (80%) and 40% of participating centers reported tier 3 barriers as contributors to inequities seen. (see Figure 1).

Conclusions: Identifying and addressing barriers to insulin pump uptake and use is fundamental to increasing use of insulin pumps and implementing meaningful changes in the process to improve equity. These concepts can be extended to use of technology in patients with T1D in general and adoption of these technologies and advanced automated closed loop systems may result in improvement in diabetes care.