Disparities in access to and use of diabetes technologies and therapeutics: a narrative review

This narrative review applies neo-materialist theory to examine disparities in diabetes care across four domains: clinical trials, diabetes technology, immunotherapies and adjuvant digital technologies. Although systemic marginalisation can occur in many forms (e.g. based on ability, language, sex, gender or age), this review focuses on marginalisation based on race, ethnicity and socioeconomic status, as these are the key areas supported by the current evidence base. Under-representation of minoritised groups in clinical trials of diabetes interventions may limit the generalisability of the data generated. Contributing factors to under-representation include historical mistrust, exclusionary criteria and lack of cultural competence in research. Potential solutions to these disparities include revising trial protocols, engaging community partners and improving recruitment strategies; however, studies examining these solutions are limited. Disparities in access to diabetes technologies, such as continuous glucose monitoring and artificial pancreas systems, appear to be influenced by intersectional factors including race, ethnicity, socioeconomic status and insurance coverage. Despite awareness of these disparities, gaps in technology use persist because the causal pathways that determine these disparities are complex. Solutions are likely to involve education, improved access and policy reforms to address social and structural determinants of health. Disparities in access to immunotherapies, particularly in type 1 diabetes, may stem in part from under-representation of minoritised groups in research. Strategies to address these disparities include ensuring equitable access and performing inclusive data collection on social determinants of health. The digital divide in diabetes care is a key barrier to adjuvant digital technology use, with unequal access to smartphones, broadband and telemedicine. Bridging this gap will require improved infrastructure, increased access to digital tools and targeted telemedicine interventions to enhance care in underserved populations. Addressing these disparities requires comprehensive multifaceted strategies that recognise the complexity of structural inequities, including policy changes, improved technology access and inclusive research practices.