Digital divide excludes older, rural and black patients from diabetes care access

Telemedicine has been hailed as a breakthrough for healthcare accessibility, but new evidence suggests that it could be reinforcing, rather than reducing, disparities in treatment for patients with type 2 diabetes. A systematic review published in the Journal of Medical Internet Research provides the strongest evidence to date that access to digital care is uneven across gender, age, race, education, and socioeconomic status.

The paper, titled “Demographic and Socioeconomic Disparities in Telemedicine Use Among Individuals With Type 2 Diabetes in Primary Care: Systematic Review and Meta-Analysis,” offers a critical look at how telemedicine is being adopted and who risks being left behind.

Who benefits most from telemedicine access?

The study found clear demographic differences in telemedicine uptake. Women were slightly more likely than men to use telemedicine services, a pattern the authors suggest may reflect broader health-seeking behaviors. However, older adults were less likely to adopt telemedicine, highlighting a generational digital divide that has long been a concern in healthcare.

Education also played a decisive role. Patients with higher education levels were significantly more likely to access telemedicine than those with less formal schooling. This gap suggests that navigating digital health platforms still requires a degree of literacy and confidence that not all patients possess.

Insurance status further amplified inequalities. Patients with private insurance were much more likely to engage with telemedicine compared to those covered by public programs. This reflects underlying disparities in healthcare access that are being replicated in the digital sphere, undermining the promise that telemedicine could bridge systemic gaps.

How do race and geography influence telemedicine use?

Racial disparities emerged as one of the most striking findings. Black patients had significantly lower odds of using telemedicine compared to White patients. Hispanic and Asian patients showed no statistically significant differences, but trends suggested lower adoption in some cases. The authors note that these findings mirror broader inequities in healthcare access and digital inclusion, where structural barriers limit engagement among minority populations.

Geography also played a defining role. Urban residents were more likely to use telemedicine than those living in rural areas, despite telemedicine’s potential to overcome physical distance. Limited broadband access, weaker digital infrastructure, and fewer resources for digital literacy in rural regions may explain these differences. The study warns that without targeted investment, telemedicine risks entrenching existing healthcare inequalities in geographically disadvantaged areas.

By highlighting these patterns, the research underscores that disparities in digital healthcare are not random but follow predictable lines of social and economic inequality. Without corrective action, these gaps could worsen outcomes for populations already at higher risk of poor diabetes management.

What does this mean for healthcare policy?

The findings raise urgent questions for policymakers and healthcare providers. Telemedicine’s expansion has been rapid, accelerated by the COVID-19 pandemic, but its uneven adoption points to a need for equity-focused strategies.

The authors argue that digital health policies must move beyond simply expanding availability and address barriers to meaningful access. This includes improving broadband infrastructure in rural areas, investing in digital literacy programs, and ensuring platforms are designed to be user-friendly for older adults and those with limited education.

Insurance reforms also loom large. As private insurance appears to facilitate access, patients dependent on public programs risk being sidelined. Policymakers must ensure that public healthcare systems integrate telemedicine services in ways that are affordable, accessible, and equitable.

Targeted interventions for racial and ethnic minorities are equally critical. This includes culturally sensitive outreach, language-accessible platforms, and stronger protections against bias in telehealth systems. Without such measures, the very groups who could benefit most from telemedicine’s promise of convenience and accessibility may remain excluded.