Outcomes for continuous subcutaneous insulin infusion users in young adults from lower socioeconomic backgrounds

Alexis M. McKee, Stewart G. Albert, Noor Al-Hammadi, Leslie J. Hinyard

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: Diabetes technology is available and its efficacy and safety have been demonstrated; however, there is little evidence as to how this technology is being utilized and its effectiveness in vulnerable populations. This study evaluated differences in outcomes for young adults in the United States (U.S.) from lower socioeconomic (SES) backgrounds with type 1 diabetes (T1D) managed on continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) or fixed-dose insulin (FDI). Research design, methods and participants: Utilizing the Optum® de-identified Electronic Health Record data set between 2008 and 2018 to perform a retrospective, cohort study, we identified 805 subjects with T1D aged 18–30 years with Medicaid. We evaluated median difference in HbA1c between CSII and MDI/FDI users for 24 months. Predictors of diabetic ketoacidosis (DKA)-associated hospitalizations by CSII use were evaluated using logistic regression. Results: CSII users showed statistically significant lower median HbA1c values at 24 months of follow-up compared to individuals on MDI/FDI. Non-white individuals were at lower odds of receiving treatment with CSII. Subjects on CSII were not more likely to be hospitalized for DKA compared to subjects treated with MDI/FDI. Older subjects were at lower odds of being hospitalized for DKA. Males and subjects followed by Endocrinologists were at higher odds of being hospitalized for DKA. Conclusions: Young adults with T1D from lower SES backgrounds show improved glycaemic control when in CSII compared to MDI/FDI without increases in hospitalizations for DKA.

Original languageEnglish
Article numbere00252
JournalEndocrinology, Diabetes and Metabolism
Issue number3
StatePublished - Jul 2021


  • continuous subcutaneous insulin infusion
  • insulin pump
  • medicaid
  • socioeconomic status
  • type 1 diabetes


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