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Published on: June 11, 2012
Self-reported insulin pump prescribing practices in pediatric type 1 diabetes
Meghan E Fredette1, Mark R Zonfrillo2, Sangshin Park3,4
1Pediatric Endocrinology and Diabetes, Hasbro Children's Hospital and the Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Insights
Pediatric endocrinology providers often use subjective factors, not objective criteria, when deciding on insulin pump therapy for type 1 diabetes. This approach may contribute to disparities in pump use among disadvantaged youth.
Area of Science:
- Pediatric Endocrinology
- Diabetes Management
- Health Disparities
Background:
- Type 1 diabetes affects youth, with insulin pump therapy offering improved glycemic control.
- Disadvantaged and minority youth with type 1 diabetes exhibit lower rates of insulin pump use compared to the majority population.
- The decision-making process for initiating insulin pump therapy by pediatric endocrinology providers is not well understood.
Purpose of the Study:
- To identify provider-specific factors influencing the decision to initiate insulin pump therapy in pediatric patients with type 1 diabetes.
- To explore the criteria used by pediatric endocrinology providers when determining eligibility for insulin pump therapy.
- To understand how provider practices may contribute to existing disparities in insulin pump utilization.
Main Methods:
- A survey was distributed to members of the Pediatric Endocrine Society who prescribe insulin pump therapy.
- The survey collected data on prescriber characteristics, adherence to guidelines, and the objective and subjective factors influencing insulin pump prescription.
- 192 eligible responses were analyzed, representing a 14.1% response rate.
Main Results:
- Most survey respondents were white, non-Hispanic, female, attending providers.
- A minority of providers (22%) followed written guidelines; most (70%) used personal guidelines for patient selection.
- Providers prioritized subjective factors like patient motivation and lifestyle over objective criteria, with few having criteria beyond standard glucose monitoring.
Conclusions:
- Pediatric endocrinology providers rely heavily on subjective patient and family factors when deciding on insulin pump initiation.
- The current decision-making process, emphasizing subjective criteria, may perpetuate disparities in insulin pump access for underserved youth.
- Implementing objective, consistent criteria is recommended to ensure equitable and safe initiation of insulin pump therapy.
Introduction:
Disadvantaged and minority youth with type 1 diabetes are less likely to be on insulin pump therapy compared to the majority population. Little is known about how pediatric endocrinology providers determine eligibility for insulin pump. We aimed to identify provider factors influencing the decision to initiate insulin pump therapy.
Methods:
We conducted a survey of Pediatric Endocrine Society members who prescribe insulin pump therapy to pediatric patients with type 1 diabetes. The survey collected information about prescriber characteristics, use and adherence to guidelines, eligibility criteria, and objective and subjective factors that influence insulin pump prescription.
Results:
The survey was completed by 192 individuals who met eligibility criteria (14.1% response rate). The majority of respondents were attending providers, and were white, non-Hispanic females. A minority of providers (22%) reported following written insulin pump guidelines, and many (70%) reported using personal guidelines to guide patient selection. Most providers had no objective eligibility criteria, aside from standard glucose monitoring. Providers identified patient lifestyle and increased risk of hypoglycemia, as well as patient and family factors such as motivation, realistic expectations of insulin pump use, ability to demonstrate carbohydrate counting, patient request, and ability to communicate as important in the decision to initiate insulin pump.
Conclusion:
Pediatric endocrinology providers place significant importance on subjective factors and utilize few objective criteria in determining eligibility for insulin pump. In the setting of the known disparities in insulin pump use, providers should utilize objective, consistent criteria to determine which patients are safe to initiate insulin pump.
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