On the final day of the 84^th Scientific Sessions, panelists discussed diabetes disparities, the importance of person-centered care, and the need for collaboration to improve patient outcomes in the session Cost and Quality—Improving Diabetes Care and the Cost of Ongoing Inequities.

“One of the key questions we’re trying to ask is how do we solve for inequities, and there’s no simple solution to this,” said Osagie Ebekozien, MD, MPH, CPHQ, T1D Exchange. “If there were, we would have solved this already. It is a complex problem. There are multiple layers involved. There are multiple issues driving some of the inequities.”

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Dr. Ebekozien emphasized the power of collaboration and how it helps identify bigger questions that need to be considered when looking at inequities. His work with the T1D Exchange spans 62 diabetes centers across 22 states and Washington, D.C., and has impacted 160,000 people living with type 1 and type 2 diabetes.  

“Our goal with this is to learn as quickly as possible and to be very intentional in ensuring that no waste in the system will bring the most optimal care in the real world quickly,” he said.

Sharing access to real-time data can help foster an environment of learning from one another, he added. It encourages conversation and discussion to ensure patients living with diabetes get the most benefits from the care they receive.

Saria Hassan, MD, MPH, Emory School of Medicine, gave an overview of the complex disparities in the United States, including disparities among youth populations, racial disparities, and geographic inequities. Using a map of three major U.S. cities, she demonstrated how certain areas with high levels of amputation correspond to areas with majority Black populations.

“This significant correlation between health disparities and racial distribution is seen over and over again,” she said.

Making the case that addressing disparities earlier in the treatment of diabetes is imperative to reduce costs, Dr. Hassan noted the risk of complications of type 2 diabetes among youth significantly increases as they transition into adulthood.

“We have to address disparities at an earlier stage,” she said. “We cannot wait and only address them in the adults for type 2 diabetes.”

Gaps in access to diabetes care are a prevalent issue as illustrated by the use of glucagon-like peptide-1 (GLP-1) receptor agonists in minority communities, Dr. Hassan said. Asian Americans with diabetes have 41% lower odds of receiving GLP-1 receptor agonists, and Black Americans have 19% lower odds of receiving GLP-1 therapy.

“We really have to think about improving access to high-quality care if we’re going to be able to reduce some of these disparities,” Dr. Hassan said.

Jennifer Raymond, MD, MCR, Children’s Hospital Los Angeles, stressed the importance of inclusive, person-centered care. She explained the challenges and benefits of virtual care groups in supporting adolescents and young adults with type 1 diabetes in marginalized communities.

Some of the challenges experienced by those who don’t have access to virtual peer groups include elevated A1C levels and the decreased use of continuous glucose monitors (CGM) and insulin pumps, she said.

“Virtual peer groups don’t equally engage all adolescents and young adults. And I think for those who are having the highest challenges and the most barriers to care, we need to be more creative, person-centered, and inclusive with approaches,” she said.

Young patients living with diabetes benefit from peer support and virtual care groups for adolescents with the disease, she noted.

“The things that ranked at the top of the list were ‘being able to see people my age using diabetes technology’ and ‘getting to learn about their experiences,’” she said. “And then ‘getting support from people my age with diabetes to help me deal with difficult feelings related to diabetes’ is interesting because these are also the places where we saw shifts in their outcomes.”

While work remains to be done to address inequalities in diabetes care, Dr. Ebekozien remains optimistic about the path going forward.

“We’ve seen indication that we’re moving in the right trajectory, and we’re going to where we need to go. We need to do that together,” he said. “And that’s the power of collaboration to really drive down the cost of the system, reduce inequities, and actually improve outcomes for all.”