Digital Divide and Diabetes Self-Management Education and Support Among Medicare Beneficiaries

PURPOSE: The purpose of the study was to determine whether sociodemographic characteristics were associated with access to digital resources among Medicare beneficiaries ages ≥65 years with reported diabetes and no prior diabetes self-management training (DSMT). METHODS: The 2022 nationally representative Medicare Current Beneficiary Survey was analyzed. A 3-level categorical dependent variable was created (n = 1783): (1) has a computer/laptop/tablet and internet access, (2) has a computer/laptop/tablet or internet access, and (3) has no access to either (reference group). A survey-weighted multinomial logit model was conducted to examine associations between sociodemographics and the dependent variable. RESULTS: Among study beneficiaries, 15.7% had no computer/laptop/tablet and no internet access, 15.8% had a computer/laptop/tablet or internet access, and 68.5% had a computer/laptop/tablet and internet access. Hispanic, non-Hispanic Black (NHB), and other minority beneficiaries were less likely than non-Hispanic White beneficiaries to have a computer/laptop/tablet and internet access (for NHB, odds ratio [OR] = 0.40, 95% CI, 0.23-0.71). Beneficiaries with less than high school (HS) or HS education were less likely to have a computer/laptop/tablet and internet access (for < HS, OR = 0.07, 95% CI, 0.04-0.12) or to have a computer/laptop/tablet or internet access (for < HS, OR = 0.41, 95% CI, 0.21-0.79). Beneficiaries with lower incomes (< $25,000) were less likely to have a computer/laptop/tablet and internet access (OR = 0.25, 95% CI, 0.15-0.41) or to have a computer/laptop/tablet or internet access (OR = 0.51, 95% CI, 0.32-0.81). CONCLUSIONS: Approximately one-third (or 3.4 million) of potential DSMT-eligible beneficiaries lacked the digital resources necessary to receive a full-service virtual DSMT. Efforts to promote enrollment in virtual DSMT must address the complexities of the digital divide for at-risk beneficiaries.