Race and Rank: New Study Questions Equal Access to MHS Healthcare

Some Youths More Likely to Get Type 1 Diabetes Technology

By Brenda L. Mooney

BETHESDA, MD—The U.S. military touts the equal access to healthcare it offers to servicemembers and beneficiaries. Despite that, new research found significant disparities in the scope and quality of care for children with Type 1 diabetes.

A study presented at this spring ENDO 2017, the annual meeting of the Endocrine Society in Orlando, determined that the disparities primarily involved access to technology to treat the condition.

“Patients now have greater access to technology to help them manage Type 1 diabetes, and some studies have reported significantly better glycemic control with the use of technology,” explained lead study author Rachael Paz, MD, a pediatric endocrinology fellow at Walter Reed National Military Medical Center, Bethesda, MD.

“Even in the U.S. military healthcare system, with equal access to and coverage of most healthcare costs, inequalities exist in the control of Type 1 diabetes and in the use of insulin pumps and continuous glucose monitors (CGMs),” Paz added. “These disparities in the utilization of currently available diabetes technology may be contributing to the differences in glycemic control we find between certain patient populations.”

Senior Airman Elenacorozal Denny, 4th Medical Operations Squadron medical technician, teaches children from the 4th Force Support Squadron Child Development Center how to use a stethoscope in March at Seymour Johnson Air Force Base, NC. The children listened to each other’s heartbeats, read books about the body and toured the pediatric clinic. Air Force photo by Airman 1st Class Victoria Boyton.

The focus of the study conducted by her and her colleagues was on whether differences exist in the use of diabetes technology in the MHS and if that had an effect on glycemic control.

To determine that, the study team retrospectively reviewed the charts of patients between 2 and 19 years of age whose parent were servicemembers. The youngsters all had Type 1 diabetes and were treated at the Walter Reed pediatric endocrinology clinics between January 2006 and August 2016.

Excluded were patients who had diabetes for less than one year, those who took less than 0.5 units of insulin per kg per day, and those with underlying conditions that required a higher hemoglobin A1c (HbA1c) goal, as well as those on NPH (neutral protamine Hagedorn) insulin.

Demographically, among the 405 dependent patients who were included in the study, the median age was 16 years, median diabetes duration was six years and median HbA1C was 8.7%. Slightly more of the subjects were male, 68.1% were white, and 53.8 had parents who were officers, not enlisted personnel.

In terms of treatment, 49.1% used an insulin pump, 20.2% used a continuous glucose monitor (CGM) and 16.5% had both. The review found that insulin pumps and CGM both were used more often by white children and officers’ children.

In fact, patients using an insulin pump were more likely to use a CGM. The study notes that 34% of patients on an insulin pump had a CGM compared to 7% of those on multiple daily injections (MDI).

Use of technology appeared to influence blood sugar levels. Patients using a pump had lower median A1c percentage, 8.4, than those on MDI, 9.1%. While the differences were not as great—8.1% vs. 8.9%—those using a CGM also had better glucose control.

While little difference was detected between use of a pump or MDI, CGM was linked to a substantially lower risk of hospitalization among the young patients—19.5%, as opposed to 33.1 of those who did not use the device.

“Our results show that disparities in the utilization of currently available diabetes technology do exist and could be contributing to differences in glycemic control between certain patient populations,” study authors concluded. “These findings highlight the need to identify root causes of these disparities and to determine processes to eliminate disparities ensuring all of our patients have the greatest opportunity to optimize their health.”

“We need to identify the root causes of these differences and devise processes that eliminate them, so all our patients can have the greatest opportunity to optimize their health,” Paz emphasized.

  1. Paz R, Carter T, Brooks D, Vogt K. (2017, April) Disparities in Diabetes Technology Use Among Military Dependents with Type 1 Diabetes within an Equal Access Healthcare System. Presented at ENDO 2017, Orlando, FL.

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