Pumping forward: The need to improve access to Insulin Pumps for Children with Type 1 Diabetes

Mr Oscar Mason¹,  Dr Shannon Pike¹, Dr Lucy Bindon¹, A/Prof. John Preddy²
1. School of Clinical Medicine, University of New South Wales, Rural Clinical Campus, Wagga Wagga
2. Associate Professor, University of New South Wales

Introduction:

There is a widespread failure to meet glycaemic targets in Australian children with type 1 diabetes, with 18% meeting the recommended HbA1c1,2. The low proportion achieving optimal glycaemic control is concerning due to the well-established link between elevated HbA1c and risk of long-term diabetic complications.

Advanced Hybrid Closed Loop (AHCL) insulin pump systems have consistently demonstrated superior glycaemic outcomes, including lower HbA1c levels, when compared to standalone insulin pumps and conventional Multiple Daily Injections (MDI)2-6.

The current Australian access scheme for insulin pump therapy is not publicly funded. Access is largely restricted to individuals with high-level private health insurance or those willing to self-fund—both of which can impose a substantial financial burden.

The sub-optimal and inequitable access to insulin pump therapy contributes to poorer individual health outcomes and imposes an increased burden on the healthcare system by having to manage complications which are preventable with early and tight glycaemic control2,7-9

Aim:

To investigate glycaemic outcomes and uptake of insulin pump therapy for children and adolescents with Type 1 Diabetes Mellitus

Methods:

We undertook a retrospective analysis of 73 patients attending a diabetes clinic in a regional city in Australia. Rates of insulin pump use were determined for those in a private health fund and not. Binary logistic regression model determined the association between health insurance and insulin pump use. The proportion achieving the HbA1c target of ≤7.0% was calculated and a multiple linear regression model explored associations.

Results:

The odds of having an insulin pump were 15.8 times higher for patients with private health funds compared to those not privately insured (95% Cl: 3.97 – 62.91, p < 0.001. Of the ten patients who met the glycaemic target, all but one were using insulin pumps. HbA1c was lower for those using insulin pumps compared with multiple daily injections (p = 0.005). HbA1c increased with age (p = 0.037).

Conclusions:

This study has demonstrated an increased uptake of insulin pump therapy for privately insured patients, which is explained by the inequities present in the current Australian funding model. The current failure to meet glycaemic targets emphasises the need to identify and implement measures to improve diabetes care. Automated insulin pump therapy provides greater glycaemic control. Hence, there is a need for children and adolescents with diabetes to have equitable access to insulin pump therapy to improve glycaemic outcomes and decrease diabetes related morbidity and mortality.

References

1.            de Bock, M., et al. ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes. Pediatr Diabetes 23, 1270-1276 (2022).

2.            Holmes-Walker, D.J., Abraham, M.B., Chee, M. & Jones, T.W. Glycaemic outcomes in Australasian children and adults with type 1 diabetes: failure to meet targets across the age spectrum. Intern Med J 53, 61-67 (2023).

3.            Michou, P., Gkiourtzis, N., Christoforidis, A., Kotanidou, E.P. & Galli-Tsinopoulou, A. The efficacy of automated insulin delivery systems in children and adolescents with type 1 diabetes Mellitus: A systematic review and meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 199, 110678 (2023).

4.            Brown, S.A., et al. Six-Month Randomized, Multicenter Trial of Closed-Loop Control in Type 1 Diabetes. N Engl J Med 381, 1707-1717 (2019).

5.            Collyns, O.J., et al. Improved Glycemic Outcomes With Medtronic MiniMed Advanced Hybrid Closed-Loop Delivery: Results From a Randomized Crossover Trial Comparing Automated Insulin Delivery With Predictive Low Glucose Suspend in People With Type 1 Diabetes. Diabetes Care 44, 969-975 (2021).

6.            Isganaitis, E., et al. Closed-Loop Insulin Therapy Improves Glycemic Control in Adolescents and Young Adults: Outcomes from the International Diabetes Closed-Loop Trial. Diabetes Technol Ther 23, 342-349 (2021).

7.            Phelan, H., et al. The Australasian Diabetes Data Network: first national audit of children and adolescents with type 1 diabetes. Med J Aust 206, 121-125 (2017).

8.            Abraham, M.B., et al. Snapshot of CGM Metrics in Adolescents and Adults Achieving Target HbA1c Versus Those Not Meeting Target HbA1c. Diabetes Technol Ther 24, 677-679 (2022).

9.            Downie, E., et al. Continued reduction in the prevalence of retinopathy in adolescents with type 1 diabetes: role of insulin therapy and glycemic control. Diabetes Care 34, 2368-2373 (2011).