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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.
Pediatric Diabetes
|April 15, 2021
Summary
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.
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