Fueled by personal experience, Maribel Baker leads Medtronic’s diabetes business toward improving health equity.

At 15 years old, Maribel Baker’s life was in the balance.

While growing up in Panama, Baker had to undergo leg surgery because she was born with one leg shorter than the other. Following the surgery, she learned that she had a staph infection. Doctors wanted to amputate the infected leg, but Baker’s parents fought for an opportunity in front of the Medical Board of Panama to bring their daughter to the U.S. for surgery, earning a grant to have the operation in Miami.

After her first surgery in Miami, Baker told Drug Delivery Business News that she was “so weak” as her mother attempted to tell the nurse something was wrong. English was the second language of Baker and her family and there was some miscommunication, but the nurse at the time denied anything was amiss. Overnight, Baker’s mother did not sleep, waiting for a new nurse shift to begin. When it did, the new nurse found internal bleeding. Baker was rushed to the ICU and received several pints of blood to save her life.

“If my parents wouldn’t have been determined to ask more questions in Panama, I would have lost my leg,” Baker said. “If my mom wouldn’t have been on top of the minute of that the nurse shift change, I would have died.”

Today, Baker is the director of health equity at Medtronic (NYSE:MDT) Diabetes. She spearheads an effort at the medtech giant to address serious inequities in diabetes care to ensure that people get the treatment they need.

Her own experience in both Panama, then the U.S., was the first indication that not everyone is treated equally.

“I feel like there are so many people that go through this, but they probably don’t have somebody in their life that is not willing to take no for an answer, like I had,” Baker said. “I feel like that’s also the reason why I am so driven in that I need to help educate people so they know what options they have and don’t give up because somebody told them that it can’t be done.”

Baker cites data showing that there is a two-to-three times lower likelihood of a Black or Hispanic individual using diabetes technology to manage their condition, even with recent adjustments for socioeconomic factors.

Disparities remain among individuals with the same coverage, similar education levels and similar income for devices like continuous glucose monitors and insulin pumps. Published data that looked at Medicare Fee for Service beneficiaries between 2017 and 2019 found that the equity gap — the difference between a White person and a person of color getting access to diabetes technology — widened from 10.6% to 17.9% over the course of that time period.

All groups increased in terms of technology utilization, yet the gap between who actually accesses the technology continued to grow bigger.

“That brings a lot of questions on what else is happening outside of costs, and outside of coverage, that means these individuals are not getting the equal opportunity to use technology,” Baker said. “There’s a lot of bias that may exist in the medical field with not everybody getting that opportunity of knowing that it’s an option for them. … That’s where we feel that, as Medtronic, we have an opportunity to really educate and train and make a difference through interventions, practical interventions  and make a difference in the utilization of technology for those individuals that we see that are not given that opportunity.”

In April 2021, Medtronic entered multiple partnerships to improve health equity for people of color living with diabetes, committing investments in partnerships with the American Diabetes Association (ADA) and the T1D Exchange, along with additional research efforts, to better understand and address such disparities.

Medtronic’s partnership with T1D Exchange supports a quality improvement pilot set to review data collected from in-person and telemedicine visits to determine baseline diabetes technology use rates among people of color who tend to have lower adoption and test interventions to determine their effects in technology adoption.

With T1D Exchange, Medtronic is creating a baseline for academic centers that represent some of the biggest endocrinology centers in the U.S. to observe differences between Black, Hispanic and White individuals with regard to diabetes technology adoption. Part of the program is unconscious bias training, with providers going through a pre-assessment to quantify bias toward placing certain people on certain technology.

Baker said a publication showed that 84.6% of providers who went through that assessment had implicit bias against public insurance. Additionally, the longer the provider was in practice, the more bias they had, while the providers that said that they recognized their bias were the ones that were “at the highest risk of having implicit bias.”

“The reason why we decided to enter this health equity partnership was because we wanted to test interventions that are practical in the U.S. to understand how changes in protocol and changes in an academic center could play a role in providing people the opportunity for technology,” Baker said.

Still, hurdles remain — as with Baker’s personal experience, the language barrier for certain patients can make receiving the proper care difficult. Medtronic currently has three insulin pump trials ongoing, all of which have the ability to switch the pump to Spanish and have the training materials in Spanish so people who speak English as a second language aren’t deterred from participating.

Ensuring that providers are diverse can support the push to get everyone the right diabetes technology, plus providing access to the right language, education, training and support can help too, Baker said. There still remains a lack of trust among patients toward certain technologies, whether it be monitors miscalculating glucose values or pumps delivering the incorrect amount of insulin.

Baker also said that someone might be put off by the technology because they’ve never seen anybody that looked like them wearing a pump or sensor.

“They might think, ‘I don’t know anybody that is wearing this, and I don’t want to be the first,’ and I think we need to address that,” Baker said. “Community health workers that can play a role, as we educate them more on the technology options to get more people to be able to talk within the community about the technology.”

Diversity in clinical trials represents another important aspect, she said, with that playing a large role in having evidence of representation from the start, demonstrating to people who question the technology that it can be effective in different communities.

Having diverse clinical staff and investigators opens up the capability to set up clinical trials in different languages. Baker said that showing people that the technology is effective in different communities can play a large with the trust component.

“Bias is one component, but I don’t think that’s the only piece that is playing a role,” Baker said. “There’s a lot more with the way our systems are structured, both on the healthcare side and our policies, and there’s a long way for us to go on that aspect.  There is access to the technology, but it’s not uniform across the entire U.S., and that’s something we need to work on.”