Odugbesan, O, Addala, A, Nelson, G, Hopkins, R, Cossen, K, Schmitt, J, Indyk, J, Yayah Jones, N-H, Agarwal, S, Rompicherla, S, Ebekozien, O

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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