JASMA

Diabetes tech has had a glow-up. What used to be a life of finger-sticks, guesswork, and “please hold while I do math in public”
now includes continuous glucose monitors (CGMs), insulin pumps, smart pens, and automated insulin delivery (AID) systems that can
adjust insulin in the background. In the best-case scenario, these tools reduce dangerous highs and lows, improve A1C and “time in range,”
and lower the daily mental load.

But here’s the part that doesn’t fit neatly on a glossy product box: access to diabetes technology in the United States is not evenly shared.
People of Colorespecially Black, Hispanic/Latino, Native communities, and some Asian American subgroupsoften face higher diabetes burden,
greater complication risk, and more barriers to specialty care. At the same time, multiple studies show that advanced diabetes technologies
are prescribed and used less often in many of these groups, even when clinical factors and insurance are taken into account.

This article breaks down what the technology can do, why disparities exist, and what patients, families, clinicians, and health systems can do
to close the gapwithout turning your life into a full-time “prior authorization enthusiast” role. (No one wants that. Not even the prior authorization people.)

Why diabetes technology matters (beyond the cool factor)

Diabetes care is relentless: decisions stack up all daymeals, stress, movement, medications, sleep, illness, hormones, work schedules,
and the occasional surprise plot twist called “life.” Technology can help by turning invisible patterns into visible signals.

Continuous glucose monitoring (CGM): the trendline advantage

A CGM measures glucose levels throughout the day and night. Instead of a single number, you get trendsrising, falling, steadyand alerts for
lows or highs. That trendline is the difference between “I feel weird” and “I’m dropping fast; I should treat now.” For many people, CGM use is
linked with improved glycemic outcomes and fewer severe events, especially when paired with education and follow-up.

Insulin pumps and AID systems: fewer manual decisions

Pumps deliver insulin continuously and can reduce the need for multiple daily injections. AID systems combine pump + CGM data with algorithms
that adjust insulin delivery based on glucose trends. They don’t eliminate diabetes, but they can reduce overnight lows, smooth out
post-meal spikes, and ease decision fatigue.

Virtual care and data-sharing: help without the extra commute

Many devices can share data with clinicians or family members (with permission). Virtual visits can make it easier to adjust settings, review patterns,
and troubleshoot. Done well, virtual care can expand access for people who face transportation barriers, rigid work schedules,
or limited local specialty care.

The real issue: technology isn’t just “available,” it’s “reachable”

In U.S. research across multiple settingsacademic centers, safety-net clinics, and large health systemsracial and ethnic disparities show up in
technology prescriptions and usage. The pattern is consistent: compared with White patients, Black and Hispanic patients are often less likely to
be prescribed CGM or pump therapy and less likely to use it over time. Studies also highlight language-related gaps (for example, lower pump use among
Spanish-language–preferring patients), which points to barriers that go beyond “patient interest.”

Importantly, this is not a story about “who cares enough” or “who is responsible.” Diabetes technology adoption is shaped by systems:
insurance rules, clinic workflows, device training, digital access, clinician assumptions, and whether a person feels respected and supported in care.
If the road to a CGM feels like a ten-level video game where every level is paperwork, it’s not surprising that fewer people “finish the quest.”

Why disparities happen: a layered mix of cost, systems, and trust

1) Coverage rules, out-of-pocket costs, and paperwork fatigue

Technology can be expensive, and coverage criteria vary by payer and (for some programs) by state. Even when a plan covers CGM or pump therapy,
patients may face deductibles, copays, supply limits, frequent renewals, or documentation requirements. These administrative hurdles hit hardest
when someone has less schedule flexibility, fewer resources to navigate appeals, or limited access to a clinician who has time to complete forms.

Policy changes can help. For example, expanded coverage criteria in major public programs have increased eligibility for CGM in recent years.
That’s a meaningful step, but implementation still depends on health system processes, pharmacy/DME pathways, and patient support.

2) Differences in specialty access and clinic support

Many people with diabetes get most of their care in primary care settings. Specialists and diabetes educators can be scarce in rural areas and
under-resourced neighborhoods. Some safety-net settings have strong wraparound support; others are stretched thin. Without device training,
follow-up, and troubleshooting, a prescription alone doesn’t translate into sustained use.

3) Digital divide: phones, apps, connectivity, and language

A lot of modern diabetes tech assumes stable internet, smartphone access, app literacy, and English-language materials. If a device requires a compatible phone
or if instructions and customer support aren’t language-concordant, the “last mile” becomes a cliff. Research on language preference and technology use suggests
that concerns about learning a pump, training gaps, and discontinuation can be higher when support isn’t aligned with a patient’s language needs.

4) Clinician bias, “who we think will do well,” and unequal offering

Multiple studies and equity analyses point to an uncomfortable reality: clinicians may unconsciously offer technology differently based on assumptions about
adherence, resources, “tech savviness,” or family support. Sometimes it’s framed as “I don’t want to overwhelm them,” but the effect can be gatekeeping.
The most equitable approach is simple: offer technology based on clinical need and patient preferencethen build the support around the patient.

5) Medical mistrust and lived experience with discrimination

Trust is not a personality trait; it’s a relationship outcome. If someone has felt dismissed, stereotyped, or rushed in health care settings,
they may be understandably cautious about adding a device that requires frequent contact with the system. A respectful approach acknowledges
the patient’s goals, listens to concerns (including privacy concerns), and avoids pressure tactics.

What “equitable diabetes tech” looks like in practice

Health equity isn’t just “giving everyone the same brochure.” It’s designing care so that people with different starting points can reach the same
quality outcomes. In diabetes technology, equity looks like consistent offering, transparent eligibility, culturally responsive education, and
a clear plan for troubleshooting and follow-up.

Health systems: the playbook that actually moves the numbers

• Standardize the offer: Build prompts into clinic workflows so eligible patients are routinely offered CGM/pump options.
• Simplify the pathway: Centralize prior authorizations, use templates, and track approvals like you track labs.
• Invest in training: Diabetes educators, pharmacists, and community health workers can make or break successful adoption.
• Measure equity outcomes: Track technology prescribing and usage by race/ethnicity and language preference, then act on gaps.
• Offer multilingual support: Provide language-concordant training, device instructions, and follow-up resources.

Clinicians: small changes with big equity impact

In real clinics, equity often hinges on a few consistent behaviors:

• Ask before assuming: “Would you like to hear about tools that could make this easier?”
• Offer choices: Different devices fit different lives (work schedules, comfort with wearables, alarm fatigue).
• Plan for the first 30 days: Early follow-up prevents frustration and drop-off.
• Teach the “why,” not just the buttons: People stick with devices when they understand how it helps their goals.

Patients and families: practical ways to advocate (without becoming a paralegal)

If you’re a person living with diabetes (or supporting someone who is), here are concrete moves that can help:

• Bring your goal to the visit: “I want fewer lows,” “I want better mornings,” or “I need something easier at work.”
• Ask directly about eligibility: “Am I eligible for a CGM or pump under my coverage? If not, what’s the exact barrier?”
• Request training: A device without training is just expensive jewelry with opinions.
• Ask for language-concordant materials: “Do you have instructions and support in my preferred language?”
• Don’t accept a vague no: If the answer is “not for you,” ask: “Based on what clinical reason?”

Also: it’s okay to decide that certain tech is not for you right now. Choosing simpler tools is not “failure.” It’s strategy.
The goal is better health and quality of life, not winning a gadget contest.

Where the future is headedand why equity must be built in, not bolted on

Diabetes technology is moving fast: smaller sensors, longer wear time, more interoperability, more automation, and more consumer-facing metabolic wearables.
But speed without equity can widen gaps. If newer tools require newer phones, stable data plans, and tech support, access will skew toward people
with higher income and more flexible care.

Another emerging issue is algorithmic fairness. Predictive models and automation can reflect the data they were trained on.
If device algorithms are developed or tested in populations that underrepresent certain racial/ethnic groups, performance differences can emerge.
Equity-focused research is increasingly pushing for diverse enrollment, transparent reporting, and evaluation of outcomes across groups.

The good news: we already know many of the fixes. Expand coverage based on clinical need. Reduce administrative barriers.
Fund education and community-based support. Measure disparities and hold systems accountable. And most importantly: include People of Color
patients, caregivers, clinicians, researchers, and advocatesin design, testing, and policy decisions from day one.

Experiences: what People of Color report about diabetes tech and care (a 500-word add-on)

The most consistent theme you hear from People of Color discussing diabetes technology isn’t “I didn’t want it.”
It’s “I didn’t know it was an option,” or “I didn’t know I could qualify,” or “I tried, but the system made it so hard I ran out of steam.”
Experiences vary widely, but several patterns come up again and again in patient stories, community forums, and clinic-based equity work.

Composite vignette #1: The invisible option. A Black woman with type 2 diabetes describes years of appointments focused mainly on medication changes
and brief diet advice. She hears about CGMs from a friendnot her clinic. When she asks, the first response is hesitant: “Those are usually for people on insulin.”
Later she learns coverage criteria can include insulin use and certain high-risk situations, and that guidelines increasingly support broader CGM access.
The turning point isn’t just getting the deviceit’s finally seeing patterns: stress spikes during shift changes, and overnight dips after late workouts.
She jokes that the graph is “a tiny professor” living on her arm, but the data helps her have a more specific conversation with her clinician.

Composite vignette #2: Language and training make or break it. A Spanish-language–preferring father of a teen with type 1 diabetes says the pump demo
felt like a speedrun through unfamiliar terms. The family leaves with a starter kit and a lot of anxiety. After a rough first monthalarms, fear of errors,
and confusion about settingsthey stop using the pump. Later, a clinic connects them with language-concordant training and a step-by-step ramp-up plan.
The technology didn’t change; the support did. The family’s takeaway: “It wasn’t that we couldn’t learn. We just needed someone to teach us in a way that fit.”

Composite vignette #3: Trust is clinical infrastructure. A Native community member describes deep skepticism about “another device” and worries about data
privacy. Their clinician doesn’t argue or dismiss concerns. Instead, the clinician asks what would make the patient feel safer, explains what data is shared,
and offers a trial period with clear opt-out options. The patient tries CGM for two weeks. Seeing repeated nighttime highs sparks a practical change:
shifting medication timing and discussing sleep quality. The patient later says, “I used to feel like diabetes was happening to me. Now I can see it.”

Across these experiences, one lesson stands out: technology adoption isn’t just a personal choice; it’s the product of being offered the option, being supported
through setup, and being treated like a capable partner in care. When clinics invest in education, simplify coverage pathways, and respect cultural and language needs,
People of Color are not only interested in diabetes techthey succeed with it. Equity doesn’t require magic. It requires follow-through.

Conclusion

Diabetes technology can meaningfully improve outcomes and quality of life, but only if it’s truly accessiblefinancially, administratively,
culturally, and practically. For People of Color, the barriers are often less about “motivation” and more about systems: coverage complexity,
uneven offering, language gaps, digital access, and the long shadow of unequal treatment in health care.

The path forward is clear. Offer technology consistently based on clinical need and patient goals. Reduce paperwork friction. Expand education and
community support. Build multilingual and culturally responsive training into standard care. And measure equity the same way we measure glucose:
regularly, transparently, and with a plan to respond when it’s off-target.

If you’re living with diabetes, you deserve tools that match your lifenot tools you can only reach if you have unlimited time, energy,
and a spare degree in insurance navigation. The future of diabetes tech should be smarter, yes. But it should also be fairer.

Medical note: This article is educational and not medical advice. Decisions about diabetes technology should be made with a licensed clinician who knows your medical history.