A Longitudinal View of Disparities in Insulin Pump Use Among Youth with Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

Abstract

Objective: To evaluate changes in insulin pump use over two decades in a national U.S. sample. Research Design and Methods: We used data from the SEARCH for Diabetes in Youth study to perform a serial cross-sectional analysis to evaluate changes in insulin pump use in participants <20 years old with type 1 diabetes by race/ethnicity and markers of socioeconomic status across four time periods between 2001 and 2019. Multivariable generalized estimating equations were used to assess insulin pump use. Temporal changes by subgroup were assessed through interactions. Results: Insulin pump use increased from 31.7% to 58.8%, but the disparities seen in pump use persisted and were unchanged across subgroups over time. Odds ratio for insulin pump use in Hispanic (0.57, confidence interval [95% CI] 0.45-0.73), Black (0.28, 95% CI 0.22-0.37), and Other race (0.49, 95% CI 0.32-0.76) participants were significantly lower than White participants. Those with ≤high school degree (0.39, 95% CI 0.31-0.47) and some college (0.68, 95% CI 0.58-0.79) had lower use compared to those with ≥bachelor's degree. Those with public insurance (0.84, 95% CI 0.70-1.00) had lower use than those with private insurance. Those with an annual household income <$25K (0.43, 95% CI 0.35-0.53), $25K-$49K (0.52, 95% CI 0.43-0.63), and $50K-$74K (0.79, 95% CI 0.66-0.94) had lower use compared to those with income ≥$75,000. Conclusion: Over the past two decades, there was no improvement in the racial, ethnic, and socioeconomic inequities in insulin pump use, despite an overall increase in use. Studies that evaluate barriers or test interventions to improve technology access are needed to address these persistent inequities.

Keywords: Diabetes disparities; Insulin pump; Insurance coverage; Socioeconomic status; Type 1 diabetes.

FIG. 1.

Adjusted predicted marginal probabilities and odds ratio for pump use over time by our subgroups of interest. (a) Race/ethnicity, (b) Parental Education, (c) Household Income and (d) Health Insurance. Figures show adjusted marginal prevalence (column graph) and adjusted odds ratio (table) for insulin pump use by patient characteristics and year. *p-Value for statistically significant differences in prevalence for pump use between period 1 (2001–2005) and period 4 (2016–2019) is noted in the table.

FIG. 1.

Adjusted predicted marginal probabilities and odds ratio for pump use over time by our subgroups of interest. (a) Race/ethnicity, (b) Parental Education, (c) Household Income and (d) Health Insurance. Figures show adjusted marginal prevalence (column graph) and adjusted odds ratio (table) for insulin pump use by patient characteristics and year. *p-Value for statistically significant differences in prevalence for pump use between period 1 (2001–2005) and period 4 (2016–2019) is noted in the table.