A Longitudinal View of Disparities in Insulin Pump Use Among Youth with Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

Abstract

Objective: To evaluate changes in insulin pump use over two decades in a national U.S. sample. Research Design and Methods: We used data from the SEARCH for Diabetes in Youth study to perform a serial cross-sectional analysis to evaluate changes in insulin pump use in participants Results: Insulin pump use increased from 31.7% to 58.8%, but the disparities seen in pump use persisted and were unchanged across subgroups over time. Odds ratio for insulin pump use in Hispanic (0.57, confidence interval [95% CI] 0.45–0.73), Black (0.28, 95% CI 0.22–0.37), and Other race (0.49, 95% CI 0.32–0.76) participants were significantly lower than White participants. Those with ≤high school degree (0.39, 95% CI 0.31–0.47) and some college (0.68, 95% CI 0.58–0.79) had lower use compared to those with ≥bachelor's degree. Those with public insurance (0.84, 95% CI 0.70–1.00) had lower use than those with private insurance. Those with an annual household income <$25K (0.43, 95% CI 0.35–0.53), $25K–$49K (0.52, 95% CI 0.43–0.63), and $50K–$74K (0.79, 95% CI 0.66–0.94) had lower use compared to those with income ≥$75,000. Conclusion: Over the past two decades, there was no improvement in the racial, ethnic, and socioeconomic inequities in insulin pump use, despite an overall increase in use. Studies that evaluate barriers or test interventions to improve technology access are needed to address these persistent inequities.