US race/ethnic disparities in diabetes technologies: a systematic review and meta-analysis of 950 000 individuals

To provide a descriptive summary and to quantitatively examine racial and ethnic disparities in the use of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) among people living with diabetes in the United States.

We followed the Cochrane and PRISMA guidelines (PROSPERO: CRD420251124678). Search was conducted on PubMed, Embase, and Cochrane up to August 2025. Observational studies were included if they (1) were conducted in the United States, (2) evaluated the use of CGM/CSII across different races/ethnic groups, and (3) reported odds ratios (ORs) for between-group comparisons. Three-level random-effect meta-analyses examined OR in the use of CGM/CSII across different groups: Non-Hispanic White (NHW; reference group) vs Black/African American, Hispanic, Asian, and Other. Subgroup analyses were conducted for children vs adults, and type 1 vs type 2 diabetes.

Totally, 1737 studies were screened, and 18 studies were included (N = 955 556 individuals). Most participants were NHW (70.9%). Approximately 40% of individuals had type 2 diabetes, and 98.9% were adults. Black/African Americans (OR = 0.47, 95% CI = 0.38-0.60), Hispanics (OR = 0.59, 95% CI = 0.50-0.69), and "Other" (OR = 0.69, 95% CI = 0.58-0.83) were less likely to use CGM, relative to NHW individuals, while Asians were equally likely. Black/African Americans (OR = 0.31, 95% CI = 0.23-0.42) and Hispanics (OR = 0.48, 95% CI = 0.42-0.55) were less likely to use a CSII when compared to NHW. No analysis was conducted for "Asian" or "Other." Limitations include moderate/substantial heterogeneity and reliance on electronic medical record data.

Racial and ethnic disparities exist in the use of diabetes technologies. Its recognition is essential to advance solutions that promote equitable care in diabetes.