Race and ethnic disparities in insulin pump and continuous glucose monitor use between 2017 and 2024: a systematic review with a focus on health equity

Diabetes mellitus (DM) technology (i.e., continuous glucose monitors (CGMs) and insulin pumps) can improve clinical outcomes and use is on the rise. However, some studies highlight disparities in DM technology prescription rates across various race/ethnicity groups. Specifically, recent studies note baseline DM technology use was significantly lower for Black patients compared to their non-Black counterparts. This systematic review examined the available evidence on the association of prescription rates for DM technology use by race/ethnicity. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analysis- Equity guidelines (PRISMA-Equity), a literature search of observational studies published between 2017 and 2024 was conducted using Medline, Cochrane, PubMed, CINAHL, and Embase databases. Articles were included if they reported data on DM technology use by race/ethnicity. All studies reported significant differences in DM technology use by race/ethnicity; with White non-Hispanic (WNH) patients having the highest prescription rates (average 56.3% (range 12–79%)), followed by patients that identify as Hispanic (average 28.8% (range 4–76%)), and Black (average 21.3% (range 3–52%)). Secondary analyses examining the influence of glycemic control, patient experience, and social determinants of health (SDoH) on the relationship between race/ethnicity and DM technology use were conducted. Limitations of included studies are discussed including (1) inaccurate measurements of race and ethnicity that failed to identify the contextual detail of ethnicity and (2) limited measurements of health outcomes and SDoH. Further research is needed to more accurately examine the factors that influence the identified race/ethnicity disparities and to develop strategies that ensure equitable access to DM technology.