"I don't know if I can call it discrimination, but..."-Perceived Discrimination in Provision of Pediatric Type 1 Diabetes (T1D) Care

Discrimination impacts health outcomes but is underexplored in pediatric T1D. In this pilot qualitative study, we evaluate perceived discrimination in provision of diabetes care for parents/guardians (PG) of youth with T1D and public insurance. PG (n=21, 39±8 yrs, youth 8±2 yrs, 67% Hispanic, 48% speak Spanish, 69% make <$50K) completed focus groups/interviews (FGI). FGI were conducted, transcribed, and coded in English (n=11) or Spanish (n=10), per PG preference. FGI transcripts were analyzed inductively by a five member bilingual team. While not always referred to as discrimination, PG reported differences in diabetes care by language, race/ethnicity, and insurance. Reported themes organically organized into the social ecological model (Figure). Systemic inequities via insurers, and institutional inequities via clinicians and schools were reported. Insurers required frequent advocacy from PG to navigate unequal treatment. Community was identified as protective through normalization and education of T1D, familial and communal support, and cultural and linguistic congruency. PG frequently described experiences in diabetes care consistent with the definition of discrimination, but not all readily adopt the terminology “discrimination”. Clinicians and researchers should be aware of this phenomenon to devise meaningful solutions to address diabetes equity. Disclosure R.Medina penaranda: None. K.K.Hood: Consultant; Cecelia Health. A.Addala: None. A.Bonilla ospina: None. H.Ortega: None. D.Pena: None. G.M.Shaw: None. L.Chamberlain: None. D.Naranjo: None. J.Raymond: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. Funding Maternal & Child Health Research Institute; National Institute of Diabetes and Digestive and Kidney Diseases (K23DK13134201)