Factors Associated With Time to Automated Insulin Delivery System Initiation in Adults With Type 1 Diabetes on...

Area of Science:

• Endocrinology
• Diabetes Technology
• Health Services Research

Background:

• Automated insulin delivery (AID) systems significantly improve glycemic control in type 1 diabetes (T1D), enhancing HbA1C and time-in-range while reducing hypoglycemia.
• The transition to AID involves a multi-step process from initial decision to system initiation, presenting potential barriers to timely adoption.

Purpose of the Study:

• To quantify the time to AID initiation (TT-AID) for adults with T1D.
• To identify factors, such as insurance status and pre-initiation visits, that influence the TT-AID.

Main Methods:

• A retrospective study analyzed electronic medical records of 114 adults with T1D initiating AID for the first time.
• Data collected included dates of AID decision, prescription, training, and initiation, with TT-AID calculated.
• Statistical tests (Wilcoxon rank-sum, log-rank) assessed differences in TT-AID based on insurance and optional AID selection visits.

Main Results:

• The median TT-AID was 89.5 days, with the most significant delays occurring between the decision and training phases.
• Patients with public insurance experienced longer initiation times (122 days) compared to those with commercial insurance (86 days).
• Attending an optional AID selection visit was associated with a significantly longer TT-AID (112 days vs. 55 days).

Conclusions:

• Adults with T1D require approximately 3 months to initiate AID systems.
• Public insurance status and participation in optional AID selection visits are associated with extended delays in AID initiation.
• Optimizing and streamlining the AID initiation pathway is crucial for reducing delays and maximizing patient benefits.