Factors Associated with Utilization and Underutilization of Diabetes Technology in Underrepresented Families Living with Type 1 Diabetes

Continuous glucose monitoring (CGM) and insulin pumps improve glycemic outcomes and quality of life for youth with type 1 diabetes, yet utilization remains suboptimal. We analyzed cross-sectional data from 84 parent-youth dyads in the Building the Evidence to Address Disparities in Type 1 Diabetes study. Youth using both CGM and pump were classified as technology utilizers. Adjusted prevalence ratios (aPR) evaluated associations of sociodemographic variables with utilization. Parents of utilizers were older (standardized mean difference [SMD] = 0.74), had higher education (SMD = 0.91), and youth had longer diabetes duration (SMD = 0.49). Underutilizers endorsed higher youth discrimination (4.23 vs 2.49, P = 0.016) and greater CGM-burden (2.34 vs 1.84, P < 0.001), while technology acceptance was higher among utilizers (4.40 vs 3.91, P = 0.007). Parental age (aPR = 1.03, 95% CI: [1.01,1.05], P = 0.003), parental education (aPR = 1.10, 95% CI: [1.01,1.19], P = 0.03), and Non-White + non-English caregivers (aPR = 1.58, 95% CI: [1.01,2.48], P = 0.046) were associated with higher utilization. Youth discrimination (aPR = 0.94, 95% CI: [0.89,1.00], P = 0.04) was associated with lower utilization. Technology utilization was associated with structural characteristics and youth-reported experiences, with youth discrimination identifying experiential factors that may influence adoption of diabetes technologies.