Related Experiment Video
Updated: Mar 16, 2026
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Low socioeconomic status is associated with adverse events in children and teens on insulin pumps under a universal
Rayzel Shulman1, Therese A Stukel2, Fiona A Miller3
1Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Sickkids Research Institute; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Insights
Children with type 1 diabetes using insulin pumps experienced diabetic ketoacidosis (DKA) and acute care events more frequently in areas with higher socioeconomic deprivation. Twenty-four-hour support did not impact these adverse events.
Area of Science:
- Pediatric Endocrinology
- Diabetes Technology
- Public Health
Background:
- Insulin pump therapy is increasingly used in pediatric type 1 diabetes management.
- Universal access programs aim to improve equitable access to diabetes technologies.
- Understanding adverse events and risk factors is crucial for optimizing care.
Purpose of the Study:
- To assess adverse events in pediatric insulin pump users under Ontario's universal funding program.
- To investigate the influence of socioeconomic status and 24-hour support on these events.
Main Methods:
- Population-based cohort study of 3193 youth (<19 years) with type 1 diabetes (2006-2013).
- Linked survey data with health administrative databases.
- Cox proportional hazards and Poisson models used to analyze time to diabetic ketoacidosis (DKA) or death and acute care events.
Main Results:
- The rate of DKA was 5.28/100 person-years and mortality was 0.033/100 person-years.
- Higher socioeconomic deprivation significantly increased the risk of DKA or death (HR 1.58) and acute care use (RR 1.60).
- Twenty-four-hour support was not associated with reduced adverse events. Higher HbA1c, prior DKA, older age, and higher nursing load were risk factors.
Conclusions:
- The safety of insulin pump therapy under universal funding is comparable to other regions.
- Socioeconomic deprivation is a significant risk factor for adverse events in pediatric diabetes care.
- Interventions targeting high-risk populations are needed to prevent poor outcomes.
Objective:
To describe adverse events in pediatric insulin pump users since universal funding in Ontario and to explore the role of socioeconomic status and 24-hour support.
Research Design And Methods:
Population-based cohort study of youth (<19 years) with type 1 diabetes (n=3193) under a universal access program in Ontario, Canada, from 2006 to 2013. We linked 2012 survey data from 33 pediatric diabetes centers to health administrative databases. The relationship between patient and center-level characteristics and time to first diabetic ketoacidosis (DKA) admission or death was tested using a Cox proportional hazards model and the rate of diabetes-related emergency department visits and hospitalizations with a Poisson model, both using generalized estimating equations.
Results:
The rate of DKA was 5.28/100 person-years and mortality 0.033/100 person-years. Compared with the least deprived quintile, the risk of DKA or death for those in the most deprived quintile was significantly higher (HR 1.58, 95% CI 1.05 to 2.38) as was the rate of diabetes-related acute care use (RR 1.60, 95% CI 1.27 to 2.00). 24-hour support was not associated with these outcomes. Higher glycated hemoglobin, prior DKA, older age, and higher nursing patient load were associated with a higher risk of DKA or death.
Conclusions:
The safety profile of pump therapy in the context of universal funding is similar to other jurisdictions and unrelated to 24-hour support. Several factors including higher deprivation were associated with an increased risk of adverse events and could be used to inform the design of interventions aimed at preventing poor outcomes in high-risk individuals.
