Black, white parents differ in perspectives on pediatric diabetes device use
Click Here to Manage Email Alerts
BALTIMORE — Multiple patient- and provider-driven barriers may contribute to racial disparities in diabetes device use by children with type 1 diabetes, according to a presenter.
In a qualitative analysis of adult’s perspectives on use of diabetes devices by their children, white parents reported experiences and observations different from those of Black parents relative to shame, pros and cons of device use, timeframe for initiating a device, use of blood glucose markers of readiness prior to initiation and need to enroll in a continuous glucose monitoring study to initiate a device.
“Both child and parent as well as provider and system factors may contribute to the racial disparities that we see in diabetes device use,” Carol Howe, PhD, RN, CDCES, director of nursing research and scholarship and the Paula R. & Ronald C. Parker Endowed Professor in Nursing at the Harris College of Nursing at Texas Christian University, told Healio.
Howe and colleagues conducted virtual interviews and focus groups with 21 parents of children with type 1 diabetes from an urban pediatric diabetes center (75% women; mean age, 44.8 years). The cohort included 12 parents of Black children and nine parents of white children. The cohort also included parents of children who did and did not use a device for managing diabetes. The Kilbourne Health Disparity Framework was used to direct content analysis and determine differences in white parents’ perceptions of diabetes device use for children compared with those of Black parents.
The majority of the study cohort said they had positive communication with the diabetes team and that the team was responsive to their child’s needs and concerns. Both Black and white parents agreed they did not want to force device use. Black parents said they did not want their child to feel different and that having a device attracted unwarranted attention, whereas white parents stated they did not want to antagonize their child by forcing the use of a device.
Five subthemes emerged where differences existed between the perspectives of Black parents and white parents. Black parents said their child felt shamed when using a device and that they felt defensive against family members and the community, whereas white parents said there were no feelings of shame and instead, there was pride in teaching the community about type 1 diabetes. Black parents also reported fear and mistrust with device use, whereas white parents viewed insulin pumps from a positive perspective.
“Besides their worry about stigma, Black parents spoke much more about the risks of diabetes devices, such as pump dislodgement or kinked tube, while white parents framed this as a hassle that was not a barrier to using devices,” Howe said.
Black parents and white parents also differed on factors related to diabetes care providers. Black parents reported being given a 1-year timeframe to learn before a device was initiated and were met with resistance when they insisted they wanted to start their child on a device. White parents expected to have early access to a device and were empowered to make their own decision regarding use. Black parents said HbA1c was used to determine readiness for a device, whereas white parents said HbA1c was not used to make that decision. Enrolling in a CGM study was mentioned as a common path to device access for Black parents, whereas studies were not mentioned by white parents.
“The ADA 2022 Standards of Care recommend early diabetes device use in patients who are appropriate and capable,” Howe said “This makes me wonder how diabetes team are deciding who is appropriate and capable. A recent survey of the Pediatric Endocrine Society found that providers used subjective rather than objective criteria to select patients for insulin pump use.”
Howe said more studies are needed to examine systemic factors that cause disparities, explore and evaluate interventions to increase a diabetes team’s awareness of racial disparities in recommending diabetes devices for children and determine whether clinical guidelines with objective criteria for device initiation need to be implemented.
Collapse
Howe C, et al. P403. Presented at: ADCES22; Aug. 12-15, 2022; Baltimore.
Click Here to Manage Email Alerts