title: Race, socioeconomic status, and treatment center are associated with insulin pump therapy in youth in the first year following diagnosis of type 1 diabetes.
abstract: 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.
  
  
  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.
authors.affiliation: 1 Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles , Los Angeles, California.
authors.forename: Maria H
authors.initials: MH
authors.lastname: Lin
authors.forename: Crystal G
authors.initials: CG
authors.lastname: Connor
authors.forename: Katrina J
authors.initials: KJ
authors.lastname: Ruedy
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
authors.forename: Craig
authors.initials: C
authors.lastname: Kollman
authors.forename: Bruce
authors.initials: B
authors.lastname: Buckingham
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Redondo
authors.forename: Desmond
authors.initials: D
authors.lastname: Schatz
authors.forename: Heidi
authors.initials: H
authors.lastname: Haro
authors.forename: Joyce M
authors.initials: JM
authors.lastname: Lee
authors.forename: William V
authors.initials: WV
authors.lastname: Tamborlane
authors.forename: Jamie R
authors.initials: JR
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000208:ethnology*; D016883:Diabetic Ketoacidosis / Q000208:ethnology / Q000517:prevention & control; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007223:Infant; D015918:Infusion Pumps, Implantable; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D017057:Medically Uninsured / Q000208:ethnology / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin