Health Equity Isn’t Optional: Racial and Socioeconomic Disparities in Type 1 Diabetes Care

Type 1 diabetes doesn’t discriminate biologically—but the systems that manage it do. From delayed diagnoses to unequal access to insulin pumps and CGMs, the experience of living with T1D in the U.S. can differ dramatically depending on race, income, and geography.

Disparities Start at Diagnosis

Black and Hispanic children are more likely to experience delayed or missed diagnoses of T1D, leading to higher rates of diabetic ketoacidosis (DKA) at first presentation. A 2023 study in JAMA Network Open found that African American children were 2.5 times more likely to be hospitalized with DKA at diagnosis than white children—a reflection not of biology, but of bias and access.

These disparities continue into adulthood. Data from the T1D Exchange Registry show that white participants are twice as likely to use insulin pumps and nearly three times as likely to use CGMs as Black participants, even when controlling for insurance type and income. Latino and Native patients face similar barriers, often due to language access issues, cost, or lack of culturally competent providers.

Systemic Causes

The inequities in T1D care are woven into the broader healthcare fabric. Structural factors include:

• Limited endocrinology access: Many rural and low-income urban areas lack pediatric or adult endocrinologists, forcing patients to rely on general practitioners for specialized care.

• Insurance restrictions: Public insurance programs often cover fewer device options, or none at all, while private insurers impose brand limits or step therapy requirements.

• Bias in clinical recommendations: Studies show that providers underestimate patients of color’s ability to use technology, leading to fewer device prescriptions.

• Cultural and linguistic gaps: Without interpreters or bilingual educators, non-English-speaking families receive less accurate diabetes education.

Policy Actions That Can Close the Gap

Achieving equity in T1D care requires systemic fixes—not charity or short-term grants. Key strategies include:

• Federal Medicaid parity laws mandating equal access to CGMs, pumps, and supplies in every state.

• Funding for community-based diabetes education programs that employ bilingual CDCESs and peer mentors.

• Demographic tracking requirements for all diabetes technology companies to publicly report who their devices are reaching—and who’s left out.

• Cultural competency training as a condition for hospital accreditation, ensuring staff can meet patients where they are.

• Expansion of tele-endocrinology services in underserved regions through federal broadband initiatives.

Several states, including Colorado and New York, are already exploring technology equity bills that would require insurers to cover CGMs for all patients with T1D. If scaled nationally, such legislation could close one of the most persistent gaps in diabetes care.

Toward True Equity

Equity in T1D care means that a child’s chance of living safely with diabetes doesn’t depend on their ZIP code or their parents’ insurance plan. Policy must make that promise real—through universal device coverage, culturally responsive education, and a healthcare workforce that reflects the people it serves.