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      The Use of Diabetes Technology to Address Inequity in Health Outcomes: Limitations and Opportunities

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          Abstract

          Purpose of Review

          The management of diabetes has been revolutionized by the introduction of novel technological treatments and modalities of care, such as continuous glucose monitoring, insulin pump therapy, and telehealth. While these technologies have demonstrated improvement in health outcomes, it remains unclear whether they have reduced inequities from racial/ethnic minority or socioeconomic status. We review the current literature to discuss evidence of benefit, current limitations, and future opportunities of diabetes technologies.

          Findings

          While there is ample evidence of the health and psychological benefit of diabetes technologies in large populations of people with type 1 and type 2 diabetes, there remain wide disparities in the use of diabetes technologies, which may be perpetuating or widening inequities. Multilevel barriers include inequitable prescribing practices, lack of support for social determinants of health, mismatch of patient preferences and care models, and cost.

          Summary

          We provide a review of disparities in diabetes technology use, possible root causes of continued inequity in outcomes, and insight into ways to overcome remaining gaps.

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          Most cited references38

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          Economic Costs of Diabetes in the U.S. in 2017

          (2018)
          OBJECTIVE This study updates previous estimates of the economic burden of diagnosed diabetes and quantifies the increased health resource use and lost productivity associated with diabetes in 2017. RESEARCH DESIGN AND METHODS We use a prevalence-based approach that combines the demographics of the U.S. population in 2017 with diabetes prevalence, epidemiological data, health care cost, and economic data into a Cost of Diabetes Model. Health resource use and associated medical costs are analyzed by age, sex, race/ethnicity, insurance coverage, medical condition, and health service category. Data sources include national surveys, Medicare standard analytical files, and one of the largest claims databases for the commercially insured population in the U.S. RESULTS The total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity. For the cost categories analyzed, care for people with diagnosed diabetes accounts for 1 in 4 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes. People with diagnosed diabetes incur average medical expenditures of ∼$16,750 per year, of which ∼$9,600 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures ∼2.3 times higher than what expenditures would be in the absence of diabetes. Indirect costs include increased absenteeism ($3.3 billion) and reduced productivity while at work ($26.9 billion) for the employed population, reduced productivity for those not in the labor force ($2.3 billion), inability to work because of disease-related disability ($37.5 billion), and lost productivity due to 277,000 premature deaths attributed to diabetes ($19.9 billion). CONCLUSIONS After adjusting for inflation, economic costs of diabetes increased by 26% from 2012 to 2017 due to the increased prevalence of diabetes and the increased cost per person with diabetes. The growth in diabetes prevalence and medical costs is primarily among the population aged 65 years and older, contributing to a growing economic cost to the Medicare program. The estimates in this article highlight the substantial financial burden that diabetes imposes on society, in addition to intangible costs from pain and suffering, resources from care provided by nonpaid caregivers, and costs associated with undiagnosed diabetes.
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            State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016–2018

            To provide a snapshot of the profile of adults and youth with type 1 diabetes (T1D) in the United States and assessment of longitudinal changes in T1D management and clinical outcomes in the T1D Exchange registry.
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              Diagnosis and Management of Diabetes: Synopsis of the 2016 American Diabetes Association Standards of Medical Care in Diabetes.

              The American Diabetes Association (ADA) published the 2016 Standards of Medical Care in Diabetes (Standards) to provide clinicians, patients, researchers, payers, and other interested parties with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care.
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                Author and article information

                Contributors
                shivani.agarwal@einsteinmed.edu
                iman.simmonds@gmail.com
                dr.akmyers@gmail.com
                Journal
                Curr Diab Rep
                Curr Diab Rep
                Current Diabetes Reports
                Springer US (New York )
                1534-4827
                1539-0829
                1 June 2022
                : 1-7
                Affiliations
                [1 ]GRID grid.240283.f, ISNI 0000 0001 2152 0791, Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, ; Bronx, NY USA
                [2 ]GRID grid.251993.5, ISNI 0000000121791997, NY Regional Center for Diabetes Translational Research, Albert Einstein College of Medicine, ; Bronx, NY USA
                [3 ]Department of Cardiology, CORE Yale, New Haven, CT 06510 USA
                [4 ]GRID grid.240382.f, ISNI 0000 0001 0490 6107, Department of Medicine, Division of Endocrinology, , North Shore University Hospital, ; Manhasset, NY USA
                [5 ]GRID grid.512756.2, ISNI 0000 0004 0370 4759, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, ; Manhasset, NY USA
                Author information
                http://orcid.org/0000-0003-4506-3702
                Article
                1470
                10.1007/s11892-022-01470-3
                9157044
                35648277
                563ff263-da67-4050-a31f-919ac8fa870a
                © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 21 March 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000062, National Institute of Diabetes and Digestive and Kidney Diseases;
                Award ID: K23DK115896-04
                Award Recipient :
                Categories
                Psychosocial Aspects (J Pierce, Section Editor)

                Endocrinology & Diabetes
                diabetes technology,continuous glucose monitors (cgm),insulin pump,telehealth,disparities

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