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

Abstract

Background: 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.

Subjects and methods: 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.

Results: 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 health 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.

Conclusions: 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.

Figures

FIG. 1.

Cumulative incidence of pump use (n=1,012).

FIG. 2.

Pump use at 1 year by risk factors. aNumber of participants with missing data: health insurance (n=22), family structure (n=2), family income (n=338), parent education (n=184), race/ethnicity (n=20), diabetic ketoacidosis (DKA) at diagnosis (n=30). bKaplan–Meier incidence. cAdjusted for clinical center. d“Other” could be living with mother, living with father, splitting time with mother and father, living with legal guardian who is not parent, living away at school, or other. eAnalyzed as an ordinal variable. fAge effect varies by center (interaction P<0.01). For Center F, the incidence of pump use was 85% (n=8), 23% (n=16), 37% (n=77), and 24% (n=37) for ages<2, 2–<5, 5–<12, and 12–<19, respectively (P<0.001). For the other six centers the corresponding percentages were 30% (n=38), 30% (n=133), 26% (n=477), and 24% (n=226) for ages<2, 2–<5, 5–<12, and 12–<19, respectively (P=0.17). gMultivariate analysis using Cox regression. The model contains all factors with an adjusted value of P<0.10 to account for potential confounding, but only values of P<0.01 are considered statistically significant in this analysis. Factors with blank entries in the multivariate columns were excluded from the model because P>0.10. The reference group for each factor is designated with a hazard ratio of 1.0.