Age, Male Gender, and Social Deprivation Are Associated with a Lower Rate of Insulin Pump Therapy Initiation in Adults with Type 1 Diabetes: A Population-Based Study

Background With advances in technology, there is an emerging concern that inequalities exist in provision and diabetes outcomes in areas of greater deprivation. We assess the relationship between socio‐economic status and deprivation with access to diabetes technology and their outcomes in adults with type 1 diabetes. Methods Retrospective, observational analysis of adults attending a tertiary centre, comprising three urban hospitals in the UK. Socio‐economic deprivation was assessed by the English Indices of Deprivation 2019. Data analysis was performed using one‐way ANOVAs and chi‐squared tests. Results In total, 1631 adults aged 44 ± 15 years and 758 (47%) women were included, with 391 (24%) using continuous subcutaneous insulin infusion, 312 (19%) using real‐time continuous glucose monitoring and 558 (34%) using intermittently scanned continuous glucose monitoring. The highest use of diabetes technology was in the least deprived quintile compared to the most deprived quintile (67% vs. 45%, respectively; p < 0.001). HbA1c outcomes were available in 400 participants; no association with deprivation was observed (p = 0.872). Participation in structured education was almost twice as high from the most deprived to the least deprived groups (23% vs. 43%; p < 0.001). Adults with white or mixed ethnicity were more likely to use technology compared to black ethnicity (60% vs. 40%; p < 0.001). Conclusions Adults living in the most deprived quintile had less technology use. Irrespective of socio‐economic status or ethnicity, glycaemia was positively affected in all groups. It is imperative that health disparities are further addressed.

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“…Our findings are comparable to previously published literature 22–24 . The greatest variation was observed with CSII use.…”

Section: Discussionsupporting

confidence: 91%

“…Our findings are comparable to previously published literature. [22][23][24] The greatest variation was observed with CSII use. A key reason may be the variation observed in structured education uptake; the percentage of people completing structured education in the least deprived group was almost double that of the most deprived group.…”

Section: Discussionmentioning

confidence: 99%

The impact of socio‐economic deprivation on access to diabetes technology in adults with type 1 diabetes

et al. 2022

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“…Decreasing insulin on board by reducing preactivity basal and/or bolus insulin, balanced with carbohydrate intake, helps manage glucose levels during PA (1). Studies show that gender plays a role in diabetes management, as men and women may have different preferred treatment options (2), psychological adjustments to T1D, and different barriers, motivations, preferences, and goals for PA (3). The objectives of this study were to determine and compare the most common strategies (type and frequency) used to prevent PA-related hypoglycemia and to compare the most common barriers to PA between selfidentified men and women.…”

mentioning

confidence: 99%

Gender Differences in Strategies to Prevent Physical Activity–Related Hypoglycemia in Patients With Type 1 Diabetes: A BETTER Study

et al. 2022

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“…Indeed, among adults with type 1 diabetes, individuals who are older, male, ethnic minorities, or of lower income are significantly less likely to use insulin pumps. [9][10][11][12][13]…”

Section: Introductionmentioning

confidence: 99%

“…Epidemiology/Health services research These differences have been observed in both countries with insulin pump funding programs (New Zealand, Denmark, France) [9][10][11] and those without (USA, Brazil). 12 13 The costs for insulin pump therapy may be paid out of pocket through private insurance coverage (which is only available for some individuals) or through government funding programs.…”

mentioning

confidence: 99%

Impact of government-funded insulin pump programs on insulin pump use in Canada: a cross-sectional study using the National Diabetes Repository

Song

Booth

Perkins

et al. 2021

BMJ Open Diab Res Care

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IntroductionInsulin pump access in type 1 diabetes may be inequitable. We studied the association between government funding programs for insulin pumps and rates of insulin pump use and disparities between pump users and non-users.Research design and methodsAdults with type 1 diabetes were identified in the National Diabetes Repository, a primary care electronic medical record database of individuals with diabetes from five Canadian provinces. Proportions of individuals using insulin pumps were compared between provinces with and without pump funding programs. Multivariable logistic regression models were used to estimate the odds of insulin pump use adjusting for confounders. Univariate logistic regression models were used to estimate the odds of insulin pump use according to each predictor, according to pump funding program status.ResultsOf 1559 adults with type 1 diabetes, proportions using insulin pumps were 47.8% (95% CI 45.1% to 50.5%) and 37.7% (95% CI 31.5% to 44.1%) in provinces with and without pump funding programs (p=0.0038). Adjusting for age, sex, HbA1c, income quintile, and rural/urban location, the OR for insulin pump use was 1.45 (1.08–1.94) for provinces with pump funding programs compared with provinces without. Higher income was associated with a greater odds of insulin pump use in provinces with pump funding programs, and rural/urban location was not associated with insulin pump use.ConclusionsInsulin pump use is more common in regions with government funding programs. Further research is required to best understand and comprehensively address persistent income disparities between pump users and non-users despite the availability of reimbursement programs.

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Age, Male Gender, and Social Deprivation Are Associated with a Lower Rate of Insulin Pump Therapy Initiation in Adults with Type 1 Diabetes: A Population-Based Study

Cited by 12 publications

References 20 publications

The impact of socio‐economic deprivation on access to diabetes technology in adults with type 1 diabetes

The impact of socio‐economic deprivation on access to diabetes technology in adults with type 1 diabetes

Gender Differences in Strategies to Prevent Physical Activity–Related Hypoglycemia in Patients With Type 1 Diabetes: A BETTER Study

Impact of government-funded insulin pump programs on insulin pump use in Canada: a cross-sectional study using the National Diabetes Repository

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