DC2439 - Persistent Disparities in Insulin Pump Uptake Despite a Universal Pump Program for Type 1 Diabetes

Blinded Abstract: Aims
We evaluated associations between social disadvantage and insulin pump use among adults with type 1 diabetes (T1D) in the context of a universal publicly-funded insulin pump program, and whether social disparities in insulin pump program enrollment have decreased over time.

Materials and Methods
Population-based cross-sectional studies were conducted using administrative healthcare data in Ontario. First, among adults >18 years old diagnosed with T1D before March 31, 2021, logistic regression was used to assess the association between neighbourhood social disadvantage (marginalization index quintiles) and insulin pump use. Second, among all pediatric and adult applicants to the insulin pump program between September 1, 2006 and March 31, 2022, ordinal logistic regression was used to evaluate associations between year of insulin pump initiation and social disadvantage.

Results
Among 27,453 adults with T1D, 60% used insulin pumps. Greater social disadvantage was associated with lower odds of insulin pump use [adjusted odds ratio [aOR) 0.44 (95% CI 0.39-0.48) for greatest vs. lowest social disadvantage quintile]. Among 21,002 pediatric and adult applicants to the insulin pump program, social disparities in pump use decreased in the first three years of the program, plateaued until 2020, then increased between 2020 and 2022, with no change in the odds of being in a higher social deprivation quintile for 2022 relative to 2007 [OR 1.09 (95% CI 0.83-1.44)].

Conclusions
Despite a universal pump program for individuals with T1D, disparities by social disadvantage persist. Residual financial and non-financial barriers must be addressed to promote equitable insulin pump uptake.