Specialized Technology Education for Pumps and Pens in Underserved Populations with Diabetes

Background: Health care disparities in the use of diabetes devices are particularly prevalent, especially given the high levels of health literacy and numeracy needed to understand their use. Methods: To reduce this gap, we created lower literacy, English and Spanish multicultural guides for insulin pen and pump use. Focus groups provided input, nonbranded illustrations were designed, and simplified text was developed. The guides were implemented in our clinic for underresourced individuals in East Los Angeles, California. Subjects given the low literacy guides participated in guide-driven individual and group education, and measures were administered at baseline, 6 and 12 months. Results: Sixty-three adults with type 1 diabetes (T1D) were included, and 43 (68%) completed all 12 months of the study. Initial HbA1c was 9.2 ± 1.97 (standard deviation) with no change over the study course (12-month A1C = 9.3 ± 1.92). However, participants showed significantly reduced psychological distress due to diabetes, increased diabetes knowledge, improved self-report of health, and a trend toward reduced depression. There was also a reduction in rates of diabetic ketoacidosis (DKA). There was no change in rates of hypoglycemia, although there was an increase in fear of hypoglycemia. Conclusions: Appropriately targeted teaching guides can be used to improve various patient-reported outcomes in people with T1D, specifically, overall self-report of health, distress due to diabetes, and diabetes knowledge. Targeted teaching guides also achieved improvements in rates of DKA in T1D. While these results are encouraging, more work is needed to make a significant impact on glycemic control. Clinical Trials registration number: NCT04550585.