Beyond access: Racial and socioeconomic disparities in device use among youth with type 1 diabetes

Racial and socioeconomic disparities in medical device use among youth with type 1 diabetes (T1D) are well documented. Inequities in access can arise in the unequal prescription of insulin pumps and continuous glucose monitoring (CGM) devices. Once prescribed, challenges to device use can also create inequities, but less is known about racial and socioeconomic disparities in post-access challenges such as barriers to use at school. Using focus group data from three mixed-method studies of youth with T1D (N=50) and their caregivers (N=56), we compare the experiences of higher-income and majority White youth to lower-income and predominantly Latinx and Black youth. We find many similarities, along with two striking differences. First, lower-income and majority Latinx and Black youth express more fear and victimization from bullying at school, which can lead to device discontinuation. Second, these youth and their caregivers report few connections to other families managing T1D but many connections to those with T2D. This social network configuration promotes the typicality assumption that these youth have T2D, which carries significant stigma and limits diabetes-related social capital that might otherwise support device use. Overall, our findings extend health inequities research by identifying unique challenges faced by lower-income and majority Latinx and Black youth with T1D in utilizing medical innovation. • Institutional conflicts make device use difficult for all youth with type 1 diabetes (T1D) • Lower-income and Latinx and Black youth with T1D face bullying and social network challenges • These youth report bullying victimization and fear shapes device use, including discontinuation • Lower-income and Latinx and Black families report few connections with T1D but more with T2D • These configurations increase T2D typicality assumption and stigma; decrease T1D social capital