Insulin pump therapy, pre‐pump hemoglobin A 1c and metabolic improvement in children with type 1 diabetes at a tertiary Canadian children's hospital
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Background and Objectives Indications for insulin pump therapy (IPT) in children with type 1 diabetes (T1D) are relatively non-specific and therefore subject to provider discretion. Health professionals' perceptions of which people will have difficulty with IPT, for example, those with higher hemoglobin A1c (HbA1c), may not be correct. This study examined the effect of IPT on HbA1c, and the role of pre-pump HbA1c on this effect. Methods All children with T1D started on IPT at British Columbia Children's Hospital from January 2011 through June 2016 were included if they had HbA1c values available both before and after IPT (n = 125). Generalized estimating equations was used to estimate the effects of IPT on HbA1c, stratified by pre-pump HbA1c levels (good: <7.5% [<58 mmol/mol], moderate: 7.5%-9.0% [58-75 mmol/mol], poor: >9.0% [>75 mmol/mol]). Results After adjusting for potential confounders, mean HbA1c decreased by 0.48% [5.2 mmol/mol] (95% confidence interval: −0.64, −0.33% [−7.0, −3.6 mmol/mol]; P < 0.0001) after IPT initiation. The adjusted mean HbA1c decreased by 0.14% [1.5 mmol/mol] (−0.35, 0.07% [−3.8, 0.8 mmol/mol]; P = 0.188), 0.54% [5.9 mmol/mol] (−0.74, −0.34% [−8.1, −3.7 mmol/mol]; P < 0.0001), and 1.08% [11.8 mmol/mol] (−1.69, −0.46% [−18.5, −5.0 mmol/mol]; P = 0.0006) after pump initiation in the good, moderate, and poor pre-pump metabolic control groups, respectively. Conclusions Pre-pump HbA1c appears to play a significant role in the effects of IPT on HbA1c, with the largest decrease in HbA1c seen in the poor pre-pump HbA1c group. Eligibility and consideration for IPT should be expanded to routinely include these children.
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Socially disadvantaged groups may have greater absolute benefit from initiating diabetes technologies given their higher HbA1c.
“However, socially disadvantaged groups may in fact have greater absolute benefit from initiating these technologies 39 , 40 given their higher HbA1c, and should be prioritised for AID.”
From Social disadvantage and technology use among adults with type 1 diabetes in Quebec: A cross‐sectional study using data from the Canadian <scp>T1D</scp> ( <scp>BETTER</scp> ) Registry (2025) · cites this paper as [40]
The Discussion reports that children with higher pre-pump HbA1c had greater HbA1c improvement after starting insulin pump therapy, supporting the possibility of greater absolute benefit for people with higher baseline HbA1c. But the study did not assess whether socially disadvantaged groups had higher HbA1c or greater benefit; its Limitations explicitly say socioeconomic status could not be addressed. It studied insulin pumps, not AID specifically. Page numbers were not available in our copy. (LLM, conf=0.88)
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- How to cite this article: Botros S, Islam N, Hursh B. Insulin pump therapy, pre-pump hemoglobin A 1c and metabolic improvement in children with type 1 diabetes at a tertiary Canadian children's hospital. Pediatr Diabetes. 2019;20: 427-433. https://doi.org/10.1111/pedi.12834
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Khodabandehloo, P., Fakembe, P., Senga, J., Shulman, R., Lipscombe, L. L., Witteman, H. O., Banerjee, A., Presseau, J., Nakhla, M., Dogba, M. J., et al. (2025) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.16426 · Cited by 6 · see citing works
- Authors
- Botros, S., Islam, N., & Hursh, B.
- Affiliations
- Western University (CA)
- Harvard University (US)
- University of British Columbia (CA)
- Corresponding author
- Hursh, Brenden
- Venue
- Pediatric Diabetes
- Publisher
- Wiley
- Published
- 2019-04
- Volume
- 20
- Issue
- 4
- Pages
- 427-433
- ISSN
- 1399-543X (ISSN-L)
- 1399-5448
- OpenAlex
- W2916614818
- Cited by
- 6
- References
- 0
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2022: 1 · 2021: 1 · 2020: 1
- FWCI
- 0.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Pediatric Diabetes (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- 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
- insulin pump therapy, type 1 diabetes, children, HbA1c, glycemic control, metabolic improvement, treatment indications, pediatric diabetes management, glycemic variability, insulin dose adjustment, hypoglycemia, HbA1c thresholds, health professional perceptions, quality of life
- MeSH terms
- British Columbia, Canada, Child, Child, Preschool, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Hospitals, Pediatric, Humans, Insulin, Insulin Infusion Systems, Male, Retrospective Studies, Tertiary Care Centers
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