Introduction and Objective: Hispanic and Black YA with T1D face stark inequity in glycemic control, hospitalizations, and mortality—driven partly by low use of insulin pumps and CGMs. Our work reveals barriers beyond insurance, including prescriber hesitancy and unmet social needs. We co-designed a health system-integrated CHW intervention with providers and patients to close gaps in technology use. Methods: In a 3-year RCT at a Bronx safety-net hospital, we randomized 114 Hispanic or Black YA (mean age 25; 82% Medicaid) to CHW support or usual endocrine care for 6 months plus 3-month follow-up. Participants using automated insulin delivery (AID) at baseline were excluded. CHWs delivered technology education, peer support, social needs navigation, and eased provider burden by managing technology prescription navigation and EMR documentation. Primary outcome was adoption of new technology (CGM, pump, or AID). Kaplan-Meier curves and Peto log-rank tests were used to examine differences by study group. Results: By 3 months, technology uptake was significantly higher and faster with CHWs vs. usual care, with durable effect at 9 months (Any tech: 74% vs. 30%, p=0.001) (Figure). Conclusion: Health system-integrated CHWs can rapidly expand diabetes technology use in underserved populations, tackling root causes of inequity while reducing provider workload. Next steps include assessing clinical outcomes, psychosocial mechanisms, and scalability. Disclosure S. Agarwal: None. P. Mathias: None. M. Finnan: None. C. Schechter: None. K. Fiori: None. A.F. Walker: None. A. Telzak: None. R. Whiskey-Lalanne: None. M.I. Manolas: None. C. Chen: None. J. Milosavljevic: None. S. Sanchez: None. A. Talla: None. J.A. Long: None. Funding National Institutes of Health (R01DK132302)
AGARWAL et al. (Fri,) studied this question.
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