Insulin pump use in pediatric patients with type 1 diabetes mellitus and demographic disparity

Aim

To assess the effectiveness of insulin pump therapy in improving glycemic control and to determine the frequency of insulin pump use among our type 1 diabetes (T1DM) patients and the factors associated with its use.

Methods

We conducted a retrospective chart review of 487 patients aged 2–18 years with a diagnosis of T1DM who attended UT pediatric endocrinology clinics between July 2020 and October 2023. Data collected included demographics, insurance type, and HbA1c values at baseline, 6 months after pump initiation, and at the most recent follow-up.

Results

Data show that 169 out of 487 patients (34.7 %) were prescribed insulin pumps, ‎with a mean age 13.72 ± 3.8 years, and 54.4% were males. Insulin pump use was 59% among non-Hispanic whites, 21.6% among Hispanics, 16.2% among African Americans, 23% among other racial and ethnic groups, 2.9% among Spanish-speaking patients, 20.9% among patients with Medicaid, and 52.8% among patients with private insurance. Data for baseline HbA1c and 6 months after initiation of insulin pump were available for 83 patients and showed a mean baseline HbA1c 7.98% and 6-month HbA1c 7.72% (P < 0.05). Median HbA1c in the most recent follow-up visit among insulin pump users was 7.8 % vs 9.4% (p < 0.001) among patients on multiple daily injections.

Conclusions

Results show a significant improvement in ‎hemoglobin A1c after starting an insulin pump, ‎indicating better glycemic control. Also, the data ‎demonstrate demographic disparities in insulin ‎pump use among pediatric patients with T1DM. ‎Data showed that insulin pump use was ‎significantly lower in racial/ethnic minorities, ‎Spanish-speaking patients, and in patients on public health insurance. Further research is ‎needed to identify and address barriers to ‎diabetes technology use.‎

Key messages

• Use of technology in pediatric diabetes.

• Technology and demographic disparity.