Transforming Access: Empowering Publicly Insured Patients With Equitable Insulin Pump Therapy

Diabetes technology, including insulin pumps, is associated with improved outcomes in youth with type 1 diabetes (T1D). However, youth with public insurance consistently demonstrate lower use. In 2022, we launched a quality improvement (QI) initiative to address disparities in insulin pump use among publicly insured youth with T1D. Our initial aim was to increase pump use from 30% to 40% within 15 months. We now report sustained and expanded outcomes, with pump use reaching 73% by December 2025.

Using a T1D-specific dashboard embedded within the electronic health record (EHR), we tracked monthly insulin pump use among publicly insured patients seen in our outpatient diabetes clinic. A multidisciplinary team designed and tested interventions through iterative plan-do-study-act cycles. Interventions included multilingual virtual and in-person insulin pump education classes, individualized one-on-one education sessions, Spanish-language educational materials, expanded class availability, targeted care navigation outreach to support scheduling and follow-up, provider implicit bias training, integration of pump screening questions into clinic intake workflows, and systematic collection of patient and family feedback through post-insulin pump class evaluations.

Insulin pump use increased from 30% in April 2022 to 42% by June 2023, and further to 73% by December 2025, reflecting sustained improvement and successful scale-up over a 44-month period.

An equity-centered, EHR-informed QI approach led to durable improvements in insulin pump use among publicly insured youth with T1D. These results demonstrate the potential for scalable, systems-based interventions to reduce disparities in diabetes technology access.