Pediatric Insulin Pump Therapy: Reflecting on the First 10 Years of a Universal Funding Program in Ontario
Open accessAbstract
We evaluated the universal funding program for pediatric insulin pumps in Ontario by examining the dynamics underlying patterns of pump use and adverse events using population-based health administrative data available at the Institute for Clinical Evaluative Sciences (ICES), supplemented by other data. We found that (1) pump use has increased steadily since 2006 with variation across centres and disparity in use by socioeconomic status; (2) pump discontinuation is uncommon; (3) physicians value pump therapy in numerous ways that provide important insights into patterns of uptake; and (4) the safety profile of pump therapy is, in general, very good; however, individuals of lower socioeconomic status are at an increased risk of acute diabetes complications, most frequently diabetic ketoacidosis. This comprehensive mixed-methods evaluation reveals the need to understand and intervene to reduce social disparities in the use and adverse outcomes of technologies used for diabetes management.
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Among the pediatric population (<18 years old) in Ontario, the proportion using insulin pumps in 2012 was reported as 38%, though this has likely increased since.
“Among the pediatric population (<18 years old) in Ontario, the proportion using insulin pumps in 2012 was reported as 38%, though this has likely increased since.26”
From Impact of government-funded insulin pump programs on insulin pump use in Canada: a cross-sectional study using the National Diabetes Repository (2021) · cites this paper as [26]
The Pump Use section reports that 38% of children with type 1 diabetes in Ontario used pumps by 2012. The claim omits the type 1 diabetes restriction, making the reported proportion sound applicable to all children under 18; the source also does not establish that exact age cutoff. It documents growth through 2012, not an increase after 2012. (LLM, conf=0.86)
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Research works printed but not linked: 12
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- Berwick, D.M. 2003. "Disseminating Innovations in Health Care." JAMA 289(15): 1969-75.
- Danne, T., T. Battelino, P. Jarosz-Chobot, O. Kordonouri, E. Pankowska, J. Ludvigsson et al. 2008. "Establishing Glycaemic Control with Continuous Subcutaneous Insulin Infusion in Children and Adolescents with Type 1 Diabetes: Experience of the PedPump Study in 17 Countries." Diabetologia 51(9): 1594-601. Diabetes Control and Complications Trial Research Group. 1994. "Effect of Intensive Diabetes Treatment on the Development and Progression of Long-Term Complications in Adolescents with Insulin- Dependent Diabetes Mellitus: Diabetes Control and Complications Trial." Journal of Pediatrics 125(2): 177-88.
- Hofer, S.E., B. Heidtmann, K. Raile, E. Frohlich-Reiterer, E. Lilienthal, M.A. Berghaeuser et al. 2010. "Discontinuation of Insulin Pump Treatment in Children, Adolescents, and Young Adults. A Multicenter Analysis Based on the DPV Database in Germany and Austria." Pediatric Diabetes 11(2): 116-21.
- Nathan, D.M., P.A. Cleary, J.Y. Backlund, S.M. Genuth, J.M. Lachin, T.J. Orchard et al. 2005. "Intensive Diabetes Treatment and Cardiovascular Disease in Patients with Type 1 Diabetes." New England Journal of Medicine 353(25): 2643-53.
- Olsen, B., J. Johannesen, S. Fredheim, J. Svensson; Danish Society for Childhood and Adolescent Diabetes. 2015. "Insulin Pump Treatment; Increasing Prevalence, and Predictors for Better Metabolic Outcome in Danish Children and Adolescents with Type 1 Diabetes." Pediatric Diabetes 16(4): 256-62.
- Phillip, M., T. Battelino, H. Rodriguez, T. Danne, F. Kaufman; European Society for Paediatric Endocrinology et al. 2007. "Use of Insulin Pump Therapy in the Pediatric Age-Group: Consensus Statement from the European Society for Paediatric Endocrinology, the Lawson Wilkins Pediatric Endocrine Society, and the International Society for Pediatric and Adolescent Diabetes, Endorsed by the American Diabetes Association and the European Association for the Study of Diabetes." Diabetes Care 30(6): 1653-62.
- Shulman, R., F.A. Miller, D. Daneman and A. Guttmann. 2016a. "Valuing Technology: A Qualitative Interview Study with Physicians about Insulin Pump Therapy for Children with Type 1 Diabetes." Health Policy 120(1): 64-71.
- Shulman, R., M.R. Palmert and D. Daneman. 2012. "Insulin Pump Therapy in Youths with Type 1 Diabetes: Uptake and Outcomes in the 'Real World'." Diabetes Management 2(2): 119-38.
- Shulman, R., T.A. Stukel, F.A. Miller, D. Daneman and A. Guttmann. 2016b. "Resources and Population Served: A Description of the Ontario Paediatric Diabetes Network." CMAJ Open 4(2): E141-46.
- Shulman, R., T.A. Stukel, F.A. Miller, A. Newman, D. Daneman, J.D. Wasserman et al. 2016d. "Low Socioeconomic Status is Associated with Adverse Events in Children and Teens on Insulin Pumps Under a Universal Access Program: A Population-Based Cohort Study." BMJ Open Diabetes Research & Care 4(1): e000239.
- Sulmont, V., V. Lassmann-Vague, B. Guerci, H. Hanaire, H. Leblanc, E. Leutenegger et al. 2011. "Access of Children and Adolescents with Type 1 Diabetes to Insulin Pump Therapy Has Greatly Increased in France Since 2001." Diabetes and Metabolism 37(1): 59-63.
Cited by
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Dekker, P., Aanstoot, H., Sas, T., de Vries, M., Birnie, E., Mul, D., & Nefs, G. (2023) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2023.0038 · Cited by 16 · see citing works
“Shulman et al. have shown large variation in pump use across centers 102 and results of single-center studies very much depend on study population, center-and HCP-level factors, country, and reimbursement arrangements.”
Alvarenga, C. S., Banca, R. L. L., Neris, R. R., Sparapani, V. D. C., Fuentealba-Torres, M., Cartagena-Ramos, D., Leal, C. L., Esper, M., & Nascimento, L. (2022) · BMC Endocrine Disorders · doi:10.1186/s12902-022-00950-7 · Cited by 15 · see citing works
Song, C., Booth, G. L., Perkins, B. A., & Weisman, A. (2021) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2021-002371 · Cited by 12 · see citing works
Mooney, S., Booth, G., Shulman, R., Na, Y.-B., Weisman, A., Shah, B., Perkins, B., & Lipscombe, L. (2021) · Diabetic Medicine · doi:10.1111/dme.14618 · Cited by 3 · see citing works
Self-citationUpdate on Medical Management of Diabetes in Children and Adolescents: Epidemiology and Treatment
Daneman, D. (2020) · Springer eBooks · doi:10.1007/978-3-030-33286-0_2 · Cited by 2 · see citing works
Self-citationFattah, L. A., Eldeeb, N. E., Farajallah, A., Shankar, P. R., & Palaian, S. (2026) · Patient Preference and Adherence · doi:10.2147/ppa.s574827
- Authors
- Shulman, R., Miller, F., Stukel, T., Daneman, D., & Guttmann, A.
- Affiliations
- University of Toronto (CA)
- Venue
- Healthcare Quarterly
- Publisher
- Longwoods Publishing
- Published
- 2017-01-27
- Volume
- 19
- Issue
- 4
- Pages
- 6-9
- ISSN
- 1710-2774 (ISSN-L)
- 1929-6347
- OpenAlex
- W2581904327
- Cited by
- 7
- References
- 18
- Citations by year
- 2026: 1 · 2023: 1 · 2022: 1 · 2021: 3 · 2020: 1
- FWCI
- 0.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Healthcare Quarterly (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- diabetes technology access, socioeconomic disparities, diabetic ketoacidosis, physician perceptions, diabetes complications, Ontario
- MeSH terms
- Adolescent, Child, Child, Preschool, Diabetes Mellitus, Type 1, Humans, Insulin, Insulin Infusion Systems, Ontario, Diabetic Ketoacidosis, Healthcare Disparities
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