Insulin Pump Use in Young Children with Type 1 Diabetes: Sociodemographic Factors and Parent-Reported Barriers
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Published on: June 11, 2012
Persis V Commissariat1, Claire T Boyle2, Kellee M Miller2
11 Joslin Diabetes Center , Harvard Medical School, Boston, Massachusetts.
Insights
Parental concerns about physical interference and effectiveness are key barriers to insulin pump use in young children with type 1 diabetes (T1D). Addressing these issues through education can improve pump adoption and glycemic control.
Area of Science:
- Pediatric Endocrinology
- Diabetes Management
- Health Services Research
Background:
- Managing type 1 diabetes (T1D) in young children poses significant challenges for families.
- Insulin pump therapy offers potential benefits for glycemic control and reducing management difficulties.
- However, the reasons behind low insulin pump uptake among young children are not well understood.
Purpose of the Study:
- To identify and describe parent-reported barriers to insulin pump use in children under 7 years old with T1D.
- To compare characteristics of children using insulin pumps versus those not using them.
- To analyze barriers among parents who considered pump therapy but did not adopt it.
Main Methods:
- A survey was administered to parents of children with T1D (duration ≥1 year, age <7) in the T1D Exchange registry.
- Demographic, clinical characteristics, and barriers to pump use were collected.
- Data from pump users and non-users were compared; barriers were analyzed for those who declined pump recommendations.
Main Results:
- The study included 515 children (mean age 5.2 years), with suboptimal glycemic control (HbA1c 8.1%).
- 64% of children used insulin pumps; pump users had higher household incomes, parental education, and more frequent blood glucose monitoring and continuous glucose monitoring (CGM) use.
- Key barriers to pump uptake included concerns about physical interference, therapeutic effectiveness, and financial burden.
Conclusions:
- Parental concerns regarding physical interference and therapeutic effectiveness are significant barriers to insulin pump adoption in young children with T1D.
- Socioeconomic factors like income and education, along with CGM use, were associated with pump adoption.
- Addressing these modifiable barriers through targeted education and behavioral interventions may improve insulin pump uptake and management outcomes.
Background:
Managing type 1 diabetes (T1D) in young children presents challenges to families and caregivers. Pump therapy may reduce challenges and benefit glycemic control. However, pump use is not universal; parent-reported reasons for lack of uptake are not well described.
Methods:
Parents of children <7, with T1D for ≥1 year, in the T1D Exchange registry completed surveys capturing demographic and clinical characteristics, as well as barriers to pump use. Data from pump users were compared to nonusers, and barriers were analyzed among parents who received pump recommendations, but decided against uptake.
Results:
Young children (N = 515) from 41 sites were identified (mean age 5.2 ± 1.2 years, diabetes duration 2.4 ± 1.0 years, 46% female, and 78% Non-Hispanic White). Overall glycemic control was suboptimal (HbA1c 8.1% ± 1.0%). The majority were pump users (64%, n = 331; nonusers 36%, n = 184). Pump users had longer T1D duration (2.5 ± 1.1 years vs. 2.2 ± 1.0 years, P = 0.001), were more likely to have annual household incomes ≥$75,000 (62% vs. 36%, P < 0.001), have a parent with college education or higher (70% vs. 45%, P < 0.001), perform more frequent blood glucose monitoring (7.5 ± 2.5 times/day vs. 6.5 ± 2.3 times/day, P < 0.001), and use continuous glucose monitoring (CGM) (45% vs. 13%, P < 0.001). Only income, education, frequency of blood glucose monitoring, and CGM use remained significant in a multivariate model including age, sex, ethnicity, and duration of diabetes. Barriers to pump uptake included concerns with physical interference, therapeutic effectiveness, and to a lesser extent, financial burden.
Conclusions:
These findings provide an opportunity to address potentially modifiable parent-reported barriers to pump uptake through education and behavioral intervention.
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