Factors Associated With Time to Automated Insulin Delivery System Initiation in Youth With Type 1 Diabetes

Initiation of automated insulin delivery (AID) systems involves a complex multistep process, starting with the shared decision of patient and provider to start an AID, followed by prescription, AID training, and AID start. We aim to assess time taken from decision to start an AID system to actual initiation of AID therapy, termed time to AID (TT-AID) and identify factors that influence the process.

This retrospective study included insulin pump naive youth with type 1 diabetes, who decided to initiate an AID system after May 2022, at the Johns Hopkins Diabetes Center. Electronic medical records and device portals were reviewed to collect demographics and AID details. Time-to-event analysis was performed.

Participants included 270 youth with T1D (median age = 12.4, 57% male, 58.9% non-Hispanic white, 4.4% Hispanic, and median diabetes duration = 0.3 years). Median TT-AID is 43.5 days, with longest duration observed between prescription and pre-AID training (median = 37.5 days). Time to AID increased significantly for participants with a diabetes duration greater than one year (40 days vs 56 days; P = .0002) and higher area deprivation index (hazard ratio [HR] = 0.95; P = .023). There were no significant differences in TT-AID based on insurance type or type of AID system.

The process of starting an AID system can be lengthy, with factors such as longer diabetes duration and high area deprivation being associated with delays in the process. Future interventions could address these factors by encouraging early AID system discussions and providing additional social support to improve the efficiency of the AID initiation process.