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Title: Race, socioeconomic status, and treatment center are associated with insulin pump therapy in youth in the first year following diagnosis of type 1 diabetes

Author
item LIN, MARIA - Children'S Hospital Los Angeles
item CONNOR, CRYSTAL - Jaeb Center For Health Research
item RUEDY, KATRINA - Jaeb Center For Health Research
item BECK, ROY - Jaeb Center For Health Research
item KOLLMAN, CRAIG - Jaeb Center For Health Research
item BUCKINGHAM, BRUCE - Stanford University
item REDONDO, MARIA - Baylor College Of Medicine
item SCHATZ, DESMOND - University Of Florida
item HARO, HEIDI - University Of Colorado
item LEE, JOYCE - University Of Michigan
item TAMBORLANE, WILLIAM - Yale University
item WOOD, JAMIE - Children'S Hospital Los Angeles
item HAYMOND, MOREY - Children'S Nutrition Research Center (CNRC)

Submitted to: Diabetes Technology & Therapeutics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/1/2013
Publication Date: 11/1/2013
Citation: Lin, M.H., Connor, C.G., Ruedy, K.J., Beck, R.W., Kollman, C., Buckingham, B., Redondo, M.J., Schatz, D., Haro, H., Lee, J.M., Tamborlane, W.V., Wood, J.R., Pediatric Diabetes Consortium. 2013. Race, socioeconomic status, and treatment center are associated with insulin pump therapy in youth in the first year following diagnosis of type 1 diabetes. Diabetes Technology & Theraputics. 15(11):929-934.

Interpretive Summary: Increasing numbers of children and adolescents with type 1 diabetes (T1D) have been placed on insulin pump therapy yet there is limited information about the use of insulin pumps during the first year. Little is known of the clinical and socioeconomic factors that may be associated with the early use of pump therapy. Therefore, we sought to determine factors associated with pump therapy within the first year in youth. Statistical methods were used to determine various factors associated with the transition from injection to pump therapy during the first year of T1D. We found that factors associated with pump use included private health insurance, having an annual household income over $100,000, and being of a non-Hispanic white race. The level of blood sugar control did not appear to influence the decision to initiate pump use. It was concluded that participants of non-Hispanic white race and of higher socioeconomic status were more likely to be placed on pumps than others. Further investigations are needed to gain a better understanding of barriers to the use of pumps in youth with T1D, especially in disadvantaged and minority families.

Technical Abstract: Increasing numbers of children and adolescents with type 1 diabetes (T1D) have been placed on insulin pump therapy. Nevertheless, data are limited regarding patterns of pump use during the first year of treatment and the clinical and socioeconomic factors associated with early use of pump therapy. Therefore, we sought to determine factors associated with pump therapy within the first year of diagnosis in youth enrolled in the Pediatric Diabetes Consortium (PDC) T1D New-Onset (NeOn) Study. The NeOn Study includes youth <19 years old at T1D diagnosis who have been followed from the time of diagnosis at seven U.S. pediatric diabetes centers. Cox regression was used to determine factors associated with transition from injection to pump therapy during the first year of T1D in 1,012 participants. Twenty-seven percent (n = 254) of participants began pump therapy within the first year of diagnosis, ranging from 18% to 59% among the seven centers. After adjusting for center effect, factors associated with pump use in multivariate analysis included private gealth insurance (37% vs. 7%; P < 0.001), having annual household income over $100,000 (50% vs. 15%; P < 0.001), and non-Hispanic white race (36% vs. 11%; P < 0.001). The hemoglobin A1c level did not appear to influence the decision to initiate pump use. Participants of non-Hispanic white race and higher socioeconomic status were more likely to be placed on pumps during the first year. Further investigations are needed to gain a better understanding of barriers to use of pumps in youth with T1D, especially in disadvantaged and minority families.