The Growing Gap in Health Equity

As a health tech VC, I support new health technologies creating the #FutureOfHealth.  However, it gives me pause to consider that these new technologies, far from helping bridge the gap, appear to widen the health equity gap, a gap that was previously evident as new medicines were brought to market. No, not everyone benefits equally from innovation. 

Racial disparities in the use of new medications are well established. For example, the Commonwealth Fund reports on the: “...Widening Treatment Inequality by Race and Insurance Coverage” in the use of new diabetes medicines. Diabetes, the chronic disease that today affects 537 million adults  globally, is itself association with race and socioeconomic status; for example, the condition’s prevalence is significantly higher in Black versus white communities ((African Americans 13.2% vs whites 7.6%.)

As it turns out, not only are there racial disparities in the disease, there are also inequities in the prevalence and use of new diabetes medication and treatment as well.  While new medications have hit the diabetes market (GLP-1 RA, DPP4-i, and SGLT2-i) not every has accessed them equally. The The Commonwealth Fund reports a 27 percent disparity in the use of new diabetes medicines between Black adults and white adults.   

What about new technologies that are beginning to be widely accessible? Unfortunately, the introduction of new technologies for diabetes management and care have not alleviated the disparity in use and care, but only widened the gap even further.  CGM (Continuous Glucose Monitoring) wearable devices are an example of a health technology offered by Dexcom and Abbot, amongst others, with an impressive list of tech buzzwords:  cloud connected, IoT (Internet of Things), with a interstitial glucose sensors, a wearable,  about the size of a quarter. (All we need is AI/ML to get to work on mountains of data that are being collected!)  CGMs track blood glucose levels continuously, and patients can benefit from this real -time monitoring,  not only for management but also for making changes in diet and lifestyle.  As a result, individuals with Type 1 and Type 2 diabetes who use a CGM are shown to have less hypoglycemia, and they experience a reduction in their average blood glucose (A1C), and overall better management of the disease.

The catch in all of this is that there is again a glaring disparity in the usage of CGMs just as in the use of medication.  Here is some data from American Diabetes Association looking at the Medicare populations.

Regardless of their age or what kind of health insurance coverage they have, states with higher rates of Black individuals who have diabetes have a lower rate of CGM access and utilization. The discrepancy is particularly stark among the Medicare population. 

So, while innovation in technology and medicine moves ahead, where is the innovation that is needed to close this gap?

#healthequity #FutureofHealth #diabetes #innovation #technology