Skip to main content

Advertisement

SpringerLink
Log in

A Systematic Review of the Effects of Provider Bias on Health in Youth and Young Adults with Type 1 Diabetes

  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Although pervasive inequities in the health outcomes of youth and young adults with type 1 diabetes (T1D) exist, the role of provider bias in these inequities is not well-understood. The purpose of this review is to synthesize evidence from existing studies on the associations between patient characteristics, provider bias, and patient health.

Recent Findings

Fourteen articles were included. Determining the extent of the effects of provider bias on patient health is limited by a lack of consensus on its definition. Experiences of provider bias (e.g., shaming, criticism) negatively affects self-esteem, relationships with medical providers, and depressive symptoms. Provider bias also impacts diabetes technology recommendations, insulin regimen intensity, and risk for life-threatening T1D complications.

Summary

Future studies are needed to develop questionnaires and interviews that better account for diverse experiences and interpretations of bias in T1D healthcare. More research is also needed to investigate mitigating factors to reduce provider bias as a way to improve psychological and physical health in individuals with T1D.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mulvey A. More people being diagnosed with type 1 diabetes. 2020. https://www.jdrf.org/blog/2020/02/18/more-people-being-diagnosed-type-1-diabetes/. Accessed February 27 2023.

  2. Mayer-Davis EJ, Beyer J, Bell RA, Dabelea D, D’Agostino R Jr, Imperatore G, et al. Diabetes in African American youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32 Suppl 2(Suppl 2):S112-22. https://doi.org/10.2337/dc09-S203.

    Article  PubMed  Google Scholar 

  3. Bell RA, Mayer-Davis EJ, Beyer JW, D’Agostino RB Jr, Lawrence JM, Linder B, et al. Diabetes in non-Hispanic white youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32 Suppl 2(Suppl 2):S102-11. https://doi.org/10.2337/dc09-S202.

    Article  PubMed  Google Scholar 

  4. Delamater AM, Shaw KH, Applegate EB, Pratt IA, Eidson M, Lancelotta GX, et al. Risk for metabolic control problems in minority youth with diabetes. Diabetes Care. 1999;22(5):700–5. https://doi.org/10.2337/diacare.22.5.700.

    Article  CAS  PubMed  Google Scholar 

  5. Gallegos-Macias AR, Macias SR, Kaufman E, Skipper B, Kalishman N. Relationship between glycemic control, ethnicity and socioeconomic status in Hispanic and white non-Hispanic youths with type 1 diabetes mellitus. Pediatr Diabetes. 2003;4(1):19–23. https://doi.org/10.1034/j.1399-5448.2003.00020.x.

    Article  PubMed  Google Scholar 

  6. Springer D, Dziura J, Tamborlane WV, Steffen AT, Ahern JH, Vincent M, et al. Optimal control of type 1 diabetes mellitus in youth receiving intensive treatment. J Pediatr. 2006;149(2):227–32. https://doi.org/10.1016/j.jpeds.2006.03.052.

    Article  PubMed  Google Scholar 

  7. Willi SM, Miller KM, DiMeglio LA, Klingensmith GJ, Simmons JH, Tamborlane WV, et al. Racial-ethnic disparities in management and outcomes among children with type 1 diabetes. Pediatrics. 2015;135(3):424–34. https://doi.org/10.1542/peds.2014-1774.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Danne T, Nimri R, Battelino T, Bergenstal RM, Close KL, DeVries JH, et al. International consensus on use of continuous glucose monitoring. Diabetes Care. 2017;40(12):1631–40. https://doi.org/10.2337/dc17-1600.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Redondo MJ, Libman I, Cheng P, Kollman C, Tosur M, Gal RL, et al. Racial/ethnic minority youth with recent-onset type 1 diabetes have poor prognostic factors. Diabetes Care. 2018;41(5):1017–24. https://doi.org/10.2337/dc17-2335.

    Article  CAS  PubMed  Google Scholar 

  10. Standards of care in diabetes-2023 abridged for primary care providers. Clin Diabetes. 2022;41(1):4–31. https://doi.org/10.2337/cd23-as01.

  11. Lipman TH, Smith JA, Patil O, Willi SM, Hawkes CP. Racial disparities in treatment and outcomes of children with type 1 diabetes. Pediatr Diabetes. 2021;22(2):241–8. https://doi.org/10.1111/pedi.13139.

    Article  PubMed  Google Scholar 

  12. Auzanneau M, Lanzinger S, Bohn B, Kroschwald P, Kuhnle-Krahl U, Holterhus PM, et al. Area deprivation and regional disparities in treatment and outcome quality of 29,284 pediatric patients with type 1 diabetes in Germany: a cross-sectional multicenter DPV analysis. Diabetes Care. 2018;41(12):2517–25. https://doi.org/10.2337/dc18-0724.

    Article  PubMed  Google Scholar 

  13. Govan L, Maietti E, Torsney B, Wu O, Briggs A, Colhoun HM, et al. The effect of deprivation and HbA1c on admission to hospital for diabetic ketoacidosis in type 1 diabetes. Diabetologia. 2012;55(9):2356–60. https://doi.org/10.1007/s00125-012-2601-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Nosek BA, Smyth FL, Hansen JJ, Devos T, Lindner NM, Ranganath KA, et al. Pervasiveness and correlates of implicit attitudes and stereotypes. Eur Rev Soc Psychol. 2007;18(1):36–88.

    Article  Google Scholar 

  15. Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94(8):666–8.

    PubMed  PubMed Central  Google Scholar 

  16. Green AR, Carney DR, Pallin DJ, Ngo LH, Raymond KL, Iezzoni LI, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007;22(9):1231–8. https://doi.org/10.1007/s11606-007-0258-5.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hausmann LR, Myaskovsky L, Niyonkuru C, Oyster ML, Switzer GE, Burkitt KH, et al. Examining implicit bias of physicians who care for individuals with spinal cord injury: a pilot study and future directions. J Spinal Cord Med. 2015;38(1):102–10. https://doi.org/10.1179/2045772313y.0000000184.

  18. Sabin JA, Greenwald AG. The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma. Am J Public Health. 2012;102(5):988–95. https://doi.org/10.2105/ajph.2011.300621.

  19. Agarwal S, Schechter C, Gonzalez J, Long JA. Racial-ethnic disparities in diabetes technology use among young adults with type 1 diabetes. Diabetes Technol Ther. 2021;23(4):306–13. https://doi.org/10.1089/dia.2020.0338.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Miller KM, Beck RW, Foster NC, Maahs DM. HbA1c levels in type 1 diabetes from early childhood to older adults: a deeper dive into the influence of technology and socioeconomic status on HbA1c in the T1D exchange clinic registry findings. Diabetes Technol Ther. 2020;22(9):645–50. https://doi.org/10.1089/dia.2019.0393.

    Article  PubMed  PubMed Central  Google Scholar 

  21. •• Addala A, Hanes S, Naranjo D, Maahs DM, Hood KK. Provider implicit bias impacts pediatric type 1 diabetes technology recommendations in the United States: findings from the Gatekeeper Study. J Diabetes Sci Technol. 2021;15(5):1027–33. An investigation of factors impacting provider recommendations for diabetes technology showed that provider implicit bias significantly impacts T1D treatment recommendations.

  22. Wong JC, Foster NC, Maahs DM, Raghinaru D, Bergenstal RM, Ahmann AJ, et al. Real-time continuous glucose monitoring among participants in the T1D exchange clinic registry. Diabetes Care. 2014;37(10):2702–9. https://doi.org/10.2337/dc14-0303.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Walker AF, Hood KK, Gurka MJ, Filipp SL, Anez-Zabala C, Cuttriss N, et al. Barriers to technology use and endocrinology care for underserved communities with type 1 diabetes. Diabetes Care. 2021;44(7):1480–90. https://doi.org/10.2337/dc20-2753.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. •• Mencher SR, Weinzimer SA, Nally LM, Van Name M, Nunez-Smith M, Sadler LS. Technology utilization in black adolescents with type 1 diabetes: exploring the decision-making process. Diabetes Technol Ther. 2022;24(4):249–57. A qualitative study of factors impacting diabetes technology use in Black adolescents showed medical mistrust and provider misunderstanding of patient culture may impact use of diabetes devices.

  25. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71. https://doi.org/10.1136/bmj.n71.

    Article  PubMed  PubMed Central  Google Scholar 

  26. (CASP) CASP. CASP qualitative studies checklist. n.d. https://casp-uk.net/casp-tools-checklists/. Accessed June 20 2022.

  27. National Heart L, and Blood Institute (NHLBI). Study quality assessment tools. n.d. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. Accessed December 9 2019.

  28. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6. https://doi.org/10.1136/bmj.39489.470347.AD.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Munn Z, Porritt K, Lockwood C, Aromataris E, Pearson A. Establishing confidence in the output of qualitative research synthesis: the ConQual approach. BMC Med Res Methodol. 2014;14:108. https://doi.org/10.1186/1471-2288-14-108.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Addala A, Igudesman D, Kahkoska AR, Muntis FR, Souris KJ, Whitaker KJ, et al. The interplay of type 1 diabetes and weight management: a qualitativestudy exploring thematic progression from adolescence to young adulthood. Pediatr Diabetes. 2019;20(7):974–85.

    Article  PubMed  PubMed Central  Google Scholar 

  31. •• Agarwal S, Crespo-Ramos G, Long JA, Miller VA. “I didn’t really have a choice”: qualitative analysis of racial-ethnic disparities in diabetes technology use among young adults with type 1 diabetes. Diabetes Technol Ther. 2021;23(9):616–22. A qualitative analysis of patient perceptions of T1D technology use revealed exacerbating factors of disparities in pump and CGM use including perceived provider gatekeeping of information about diabetes devices and limited opportunities for shared decision making.

  32. Auslander WF, Thompson SJ, Dreitzer D, Santiago JV. Mothers’ satisfaction with medical care: perceptions of racism, family stress, and medical outcomes in children with diabetes. Health Soc Work. 1997;22(3):190–9.

    Article  CAS  PubMed  Google Scholar 

  33. Crespo-Ramos G, Cumba-Avilés E, Quiles-Jiménez M. “They called me a terrorist”: social and internalized stigma in Latino youth with type 1 diabetes. Health Psychol Rep. 2018;6:307–20.

    Article  PubMed  Google Scholar 

  34. Haugvik S, Beran D, Klassen P, Hussain A, Haaland A. “My heart burns” – a qualitative study of perceptions and experiences of type 1 diabetes among children and youths in Tajikistan. Chronic Illn. 2017;13:128–39.

    Article  PubMed  Google Scholar 

  35. Ingersgaard MV, Hoeeg D, Willaing I, Grabowski D. An exploratory study of how young people experience and perceive living with type 1 diabetes during late adolescence and emerging adulthood. Chronic Illn. 2021;17(4):475–92.

    Article  PubMed  Google Scholar 

  36. Jeong YM, Quinn L, Kim N, Martyn-Nemeth P. Health-related stigma in young adults with type 1 diabetes mellitus. J Psychosoc Nurs Ment Health Serv. 2018;56(10):44–51.

    Article  PubMed  Google Scholar 

  37. King KM, King PJ, Nayar R, Wilkes S. Perceptions of adolescent patients of the “lived experience” of type 1 diabetes. Diabetes Spectrum. 2017;30(1):23–35.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kratzer J. Structural barriers to coping with type 1 diabetes mellitus in Ghana: experiences of diabetic youth and their families. Ghana Med J. 2012;46(2):39–45.

    CAS  PubMed  PubMed Central  Google Scholar 

  39. •• Montali L, Zulato E, Cornara M, Ausili D, Luciani M. Barriers and facilitators of type 1 diabetes self-care in adolescents and young adults. J Pediatr Nurs. 2022;62:136–43. A qualitative evaluation of barriers and facilitators to T1D self-care revealed provider-level barriers including limited emphasis on psychological well-being and transition from pediatric to adult endocrinology.

  40. Morone JF, Teitelman AM, Cronholm PF, Hawkes CP, Lipman TH. Influence of social determinants of health barriers to family management of type 1 diabetes in Black single parent families: a mixed methods study. Pediatr Diabetes. 2021;22(8):1150–61.

    Article  PubMed  Google Scholar 

  41. Valenzuela JM, La Greca AM, Hsin O, Taylor C, Delamater AM. Prescribed regimen intensity in diverse youth with type 1 diabetes: role of family and provider perceptions. Pediatr Diabetes. 2011;12(8):696–703.

    Article  PubMed  Google Scholar 

  42. Dressler WW. Stress and adaptation in the context of culture. New York: State University of New York Press; 1991.

    Google Scholar 

  43. McCubbin HI, Thompson AIE. Family assessment inventories for research and practice. Madison: University of Wisconsin; 1987.

    Google Scholar 

  44. Ware JE Jr, Snyder MK, Wright WR, Davies AR. Defining and measuring patient satisfaction with medical care. Eval Program Plann. 1983;6(3–4):247–63. https://doi.org/10.1016/0149-7189(83)90005-8.

    Article  PubMed  Google Scholar 

  45. Hanson CL, Henggeler SW, Burghen GA. Model of associations between psychosocial variables and health-outcome measures of adolescents with IDDM. Diabetes Care. 1987;10(6):752–8. https://doi.org/10.2337/diacare.10.6.752.

    Article  CAS  PubMed  Google Scholar 

  46. World Health Organization. Reducing the burden of noncommunicable diseases through strengthening of prevention and control of diabetes. In: Seventy-Fourth World Health Assembly. 2021. https://apps.who.int/gb/ebwha/pdf_files/WHA74-REC1/A74_REC1-en.pdf.

  47. World Health Organization. Mid-point evaluation of the implementation of the WHO global action plan for the prevention and control of noncommunicable diseases 2013–2020. In: Seventy-Fourth World Health Assembly. 2021. https://apps.who.int/gb/ebwha/pdf_files/WHA74-REC1/A74_REC1-en.pdf.

  48. Nguyen LA, Pouwer F, Winterdijk P, Hartman E, Nuboer R, Sas T, et al. Prevalence and course of mood and anxiety disorders, and correlates of symptom severity in adolescents with type 1 diabetes: results from diabetes LEAP. Pediatr Diabetes. 2021;22(4):638–48. https://doi.org/10.1111/pedi.13174.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Van Tilburg MA, McCaskill CC, Lane JD, Edwards CL, Bethel A, Feinglos MN, et al. Depressed mood is a factor in glycemic control in type 1 diabetes. Psychosom Med. 2001;63(4):551–5. https://doi.org/10.1097/00006842-200107000-00005.

    Article  PubMed  Google Scholar 

  50. Berger M, Leicht A, Slatcher A, Kraeuter AK, Ketheesan S, Larkins S, et al. Cortisol awakening response and acute stress reactivity in First Nations people. Sci Rep. 2017;7:41760. https://doi.org/10.1038/srep41760.

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  51. Miller GE, Chen E, Zhou ES. If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychol Bull. 2007;133(1):25–45. https://doi.org/10.1037/0033-2909.133.1.25.

    Article  PubMed  Google Scholar 

  52. Ogungbe O, Mitra AK, Roberts JK. A systematic review of implicit bias in health care: a call for intersectionality. IMC J Med Sci. 2019;13(1):005.

    Article  Google Scholar 

  53. Govender V, Penn-Kekana L. Gender biases and discrimination: a review of health care interpersonal interactions. Glob Public Health. 2008;3(Suppl 1):90–103. https://doi.org/10.1080/17441690801892208.

    Article  PubMed  Google Scholar 

  54. American Psychiatric Association. Cultural formulation interview. In: Diagnostic and statistical manual of mental disorders, 5th edn. Arlington, VA. 2013;745–759.

  55. Yudell M, Roberts D, DeSalle R, Tishkoff S, 70 signatories. NIH must confront the use of race in science. Science. 2020;369(6509):1313–4. https://doi.org/10.1126/science.abd4842.

  56. Maghbouleh N, Schachter A, Flores RD. Middle Eastern and North African Americans may not be perceived, nor perceive themselves, to be White. Proc Natl Acad Sci. 2022;119(7):e2117940119. https://doi.org/10.1073/pnas.2117940119.

  57. Divers J, Mayer-Davis EJ, Lawrence JM, Isom S, Dabelea D, Dolan L, et al. Trends in incidence of type 1 and type 2 diabetes among youths - selected counties and Indian reservations, United States, 2002–2015. MMWR Morb Mortal Wkly Rep. 2020;69(6):161–5. https://doi.org/10.15585/mmwr.mm6906a3.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Health NIo. NIH guidelines on the inclusion of women and minorities as subjects in clinical research. Fed Regist. 1994;59:1408–13.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical and Health Psychology, University of Florida, 1225 Center Dr., Gainesville, FL, 32610, USA

    Sara E. Wetter-Wren, Alexandra C. Himelhoch & Kimberly A. Driscoll

Authors
  1. Sara E. Wetter-Wren
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexandra C. Himelhoch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kimberly A. Driscoll
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kimberly A. Driscoll.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This review does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wetter-Wren, S.E., Himelhoch, A.C. & Driscoll, K.A. A Systematic Review of the Effects of Provider Bias on Health in Youth and Young Adults with Type 1 Diabetes. Curr Diab Rep 24, 45–60 (2024). https://doi.org/10.1007/s11892-023-01527-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-023-01527-x

Keywords

Search

Navigation