Race, socioeconomic status, and treatment center are associated with insulin pump therapy in youth in the first year following diagnosis of type 1 diabetes
Open accessAbstract
Background: Increasing numbers of children and adolescents with type 1 diabetes (T1D) have been placed on insulin pump therapy. Nevertheless, data are limited regarding patterns of pump use during the first year of treatment and the clinical and socioeconomic factors associated with early use of pump therapy. Therefore, we sought to determine factors associated with pump therapy within the first year of diagnosis in youth enrolled in the Pediatric Diabetes Consortium (PDC) T1D New-Onset (NeOn) Study. Subjects and Methods: The NeOn Study includes youth <19 years old at T1D diagnosis who have been followed from the time of diagnosis at seven U.S. pediatric diabetes centers. Cox regression was used to determine factors associated with transition from injection to pump therapy during the first year of T1D in 1,012 participants. Results: Twenty-seven percent ( n =254) of participants began pump therapy within the first year of diagnosis, ranging from 18% to 59% among the seven centers. After adjusting for center effect, factors associated with pump use in multivariate analysis included private health insurance (37% vs. 7%; P <0.001), having annual household income over $100,000 (50% vs. 15%; P <0.001), and non-Hispanic white race (36% vs. 11%; P <0.001). The hemoglobin A1c level did not appear to influence the decision to initiate pump use. Conclusions: Participants of non-Hispanic white race and higher socioeconomic status were more likely to be placed on pumps during the first year. Further investigations are needed to gain a better understanding of barriers to use of pumps in youth with T1D, especially in disadvantaged and minority families.
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Adoption of pump therapy in the U.S. shows geographical variations, which may be related to health care professional preference or center characteristics and socioeconomic status, as pump therapy is more common in individuals of higher socioeconomic status.
“Adoption of pump therapy in the U.S. shows geographical variations, which may be related to health care professional preference or center characteristics (165,166) and socioeconomic status, as pump therapy is more common in individuals of higher socioeconomic status, as reflected by private health insurance, family income, and education (165,166).”
From 7. Diabetes Technology: Standards of Care in Diabetes—2025 (2025) · cites this paper as [165]
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Clarke, A. B. M., Ahsan, H., Harrington, J., & Mahmud, F. H. (2019) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2019.11.004 · Cited by 6 · see citing works
Bächle, C., Stahl‐Pehe, A., Castillo, K., Selinski, S., Holl, R. W., & Rosenbauer, J. (2020) · Pediatric Diabetes · doi:10.1111/pedi.13166 · Cited by 6 · see citing works
“001), although the association weakened in the multivariable analyses, and the group of youths who did not live with both parents was heterogeneous.(28) In two studies analyzing CSII discontinuation, CSII use at baseline was disproportionately low in subjects not living with at least two caregivers (40.”
ResultLuo, X., Pan, J., Lu, H., & Li, X. (2021) · Nursing Open · doi:10.1002/nop2.971 · Cited by 6 · see citing works
Grundman, J., PERKINS, A. G., Monaghan, M. C., Meighan, S., Streisand, R. M., & Marks, B. E. (2023) · Journal of Clinical & Translational Endocrinology · doi:10.1016/j.jcte.2023.100319 · Cited by 5 · see citing works
“Patients of historically marginalized racial and ethnic backgrounds and those of lower socioeconomic statuses commonly report seeking access to diabetes technologies only to be dissuaded by their clinician due to poor glycemic control [17] or biased assessment readiness and ability to initiate insulin pump therapy [18…”
BackgroundSocio‐economic disparities in hospital care among Dutch patients with diabetes mellitus
de Vries, S. A. G., Sas, T., Bak, J. C. G., Mul, D., Nieuwdorp, M., Wouters, M. W. J. M., & Verheugt, C. L. (2024) · Diabetes Obesity and Metabolism · doi:10.1111/dom.15440 · Cited by 4 · see citing works
“9,25 – 27 Similar to our findings, girls in Germany more often used CSII, and this was not significant for CGM use.”
Social and Structural Determinants of Cardiovascular Complications of Diabetes
MENSAH, P. A., VALDEZ, K., Gyawali, A., & Snell‐Bergeon, J. K. (2024) · Current Diabetes Reports · doi:10.1007/s11892-024-01541-7 · Cited by 5 · see citing works
“More individuals with private health insurance receive insulin pumps to manage diabetes [87, 88], which boosts glycemic control [89].”
Lee, Y. J., Lee, Y. A., Kim, J. H., Chung, H. R., Gu, M. J., Kim, J. Y., & Shin, C. H. (2020) · Annals of Pediatric Endocrinology & Metabolism · doi:10.6065/apem.2040048.024 · Cited by 4 · see citing works
Overview of Currently Available Insulin Delivery Systems
Fried, H. (2024) · Contemporary Endocrinology · doi:10.1007/978-3-031-75352-7_2 · Cited by 3 · see citing works
Pickup, J. C. (2017) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2017.2503 · Cited by 3 · see citing works
El-Samahy, M. H., Salah, N. Y., Abdeen, M. S., & Falastin, B. R. K. (2022) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-022-00853-6 · Cited by 3 · see citing works
Glycemic control and sponsor rank of military dependents with type 1 diabetes mellitus
Paz, R., Rouhanian, M., & Vogt, K. S. (2015) · Pediatric Diabetes · doi:10.1111/pedi.12306 · Cited by 3 · see citing works
CROMER, S. J., Wexler, D. J., & Kazemian, P. (2021) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2021.108825 · Cited by 3 · see citing works
Tremblay, E. S., & Laffel, L. M. (2025) · Journal of Diabetes Science and Technology · doi:10.1177/19322968251345836 · Cited by 2 · see citing works
“18-20 While prior studies have identified similar disparities in the implementation of CSII among socially disadvantaged youth with T1D 9,15,21 and the persistence of these disparities over time, 10 our study adds to this literature by demonstrating that publicly insured, non-White, and youth from…”
Ye, Y., Acevedo-Mendez, B. A., Izard, S. M., & Myers, A. K. (2023) · Diabetes Spectrum · doi:10.2337/ds23-0013 · Cited by 2 · see citing works
UK service level audit of insulin pump therapy in paediatrics
Ghatak, A., Paul, P., Hawcutt, D. B., White, H. D., Furlong, N. J., Saunders, S., Morrison, G., Langridge, P., & Weston, P. J. (2015) · Diabetic Medicine · doi:10.1111/dme.12782 · Cited by 2 · see citing works
Timing of insulin pump initiation among individuals with type 1 diabetes in Ontario, Canada
Zhu, X., Lipscombe, L. L., Shulman, R. M., Lovblom, L. E., Everett, K., & Weisman, A. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.70514 · Cited by 1 · see citing works
“8,17 19 – 22 Fewer studies have examined associations between physician characteristics and insulin pump uptake.”
Social Determinants of Health Impact on Pediatric Type 1 Diabetes Outcomes Early after Diagnosis
Marks, B., Hecklinger, C., Meyer, A., Reyling, J., Linn, S. E., Olson, K. E., Miller, K. R., & Alonso, G. T. (2026) · Hormone Research in Paediatrics · doi:10.1159/000551650 · Cited by 1 · see citing works
An Ethical Perspective on the Social Value of Cell-Based Technologies in Type 1 Diabetes
de Jongh, D., & Bunnik, E. M. (2023) · Springer eBooks · doi:10.1007/978-3-031-41943-0_19 · Cited by 1 · see citing works
Santos, T. J. D., Campos, J. D. M. D., Medín, C. A. F., Argente, J., & Rodríguez‐Artalejo, F. (2019) · Systematic Reviews · doi:10.1186/s13643-019-1171-9 · Cited by 1 · see citing works
McKee, A. M., Albert, S. G., Al-Hammadi, N. J., & Hinyard, L. (2021) · Endocrinology Diabetes & Metabolism · doi:10.1002/edm2.252 · Cited by 1 · see citing works
Insulin pumps in children with T1DM—we told you so
Tamborlane, W. V., & Sherr, J. L. (2013) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2013.190
Self-citationRegulatory Aspects of New Technology in Diabetes: Can Research Help Us?
de Beaufort, C. E., & Lehmann, B. (2016) · Springer eBooks · doi:10.1007/978-3-319-40242-0_16
Shulman, R. M. (2015) · TSpace (University of Toronto)
Manuscripts Reviewed for the 2014 Yearbook
(2015) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2015.1515
Delamater, A. M., Pulgarón, E. R., Guevara, G., Washington, S., Franz, D. Z., Gómez, R., Felipe, D. L., Bhat, J. N., & Chalew, S. A. (2025) · The Science of Diabetes Self-Management and Care · doi:10.1177/26350106251397906
- Authors
- Lin, M. H., Connor, C. G., Ruedy, K. J., Beck, R. W., Kollman, C., Buckingham, B., Redondo, M. J., Schatz, D., Haro, H., Lee, J. M., Tamborlane, W. V., & Wood, F. T. P. D. C.
- Affiliations
- Children's Hospital Los Angeles (US)
- Jaeb Center for Health Research (US)
- Stanford Medicine (US)
- Baylor College of Medicine (US)
- University of Florida (US)
- University of Colorado Anschutz (US)
- University of Michigan (US)
- Yale University (US)
- Children's Hospital Los Angeles
- Corresponding author
- Lin, Maria H.
- ORCID
- Venue
- Diabetes Technology & Therapeutics
- Publisher
- SAGE Publications
- Published
- 2013-11
- Volume
- 15
- Issue
- 11
- Pages
- 929-934
- ISSN
- 1520-9156 (ISSN-L)
- 1557-8593
- PMC
- PMC3817890
- OpenAlex
- W2025728063
- Cited by
- 81
- References
- 14
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 6 · 2023: 10 · 2022: 10 · 2021: 11 · 2020: 8 · 2019: 7 · 2018: 7 · 2017: 3 · 2016: 6 · 2015: 5 · 2014: 1 · 2013: 1
- FWCI
- 3.42
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetes Technology & Therapeutics (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- Novo Nordisk
- National Institute of Diabetes and Digestive and Kidney Diseases (DK020572, P30DK020572)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- type 1 diabetes, insulin pump therapy, children and adolescents, racial disparities, socioeconomic status, health insurance, household income, HbA1c
- MeSH terms
- Adolescent, Age Factors, Blood Glucose, Child, Child, Preschool, Diabetes Mellitus, Type 1, Female, Health Services Accessibility, Humans, Hypoglycemic Agents, Infant, Insulin, Insulin Infusion Systems, Male, Socioeconomic Factors, United States, Blood Glucose Self-Monitoring, Infusion Pumps, Implantable, Diabetic Ketoacidosis, Medically Uninsured, Healthcare Disparities
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