title: Pediatric Insulin Pump Therapy: Reflecting on the First 10 Years of a Universal Funding Program in Ontario.
abstract: 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.
authors.affiliation: Staff physician in the Division of Endocrinology at The Hospital for Sick Children; an assistant professor in the Department of Pediatrics at the University of Toronto; and a postdoctoral fellow at ICES.
authors.forename: Rayzel
authors.initials: R
authors.lastname: Shulman
authors.affiliation: Associate professor of health policy in the Institute of Health Policy, Management and Evaluation; director of the Division of Health Policy and Ethics at the Toronto Health Economics and Technology Assessment Collaborative (THETA); and a member of the Joint Centre for Bioethics at the University of Toronto.
authors.forename: Fiona A
authors.initials: FA
authors.lastname: Miller
authors.affiliation: Senior core scientist at ICES and a professor at the Institute of Health Policy, Management and Evaluation, University of Toronto.
authors.forename: Thérèse A
authors.initials: TA
authors.lastname: Stukel
authors.affiliation: Professor and chair emeritus of pediatrics at the University of Toronto and pediatrician-in-chief emeritus at The Hospital for Sick Children in Toronto.
authors.forename: Denis
authors.initials: D
authors.lastname: Daneman
authors.affiliation: Chief science officer at ICES, a staff pediatrician in the Division of Paediatric Medicine at The Hospital for Sick Children, and an associate professor in the Department of Paediatrics and the Institute of Health Policy, Management and Evaluation at the University of Toronto.
authors.forename: Astrid
authors.initials: A
authors.lastname: Guttmann
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology; D054625:Healthcare Disparities; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D007332:Insulin Infusion Systems / Q000009:adverse effects* / Q000191:economics* / Q000706:statistics & numerical data; D009864:Ontario
chemical_list: D007328:Insulin