Pilot Study of Early Adoption of Automated Insulin Delivery in Underresourced Youth

TL;DR

This pilot study shows that starting automated insulin delivery soon after diagnosis is feasible and acceptable for underresourced youth with Type 1 diabetes.

Contribution

The study demonstrates early AID adoption feasibility in underresourced youth, a population with historically low technology use.

Findings

A larger proportion of the AID group achieved the ADA time-in-range benchmark compared to the control group.

Most caregivers and youth in the AID group reported satisfaction and continued use after the study.

Focus groups highlighted favorable experiences with AID use among participants.

Abstract

Disparities in outcomes and technology use in children with Type 1 diabetes (T1D) from underresourced backgrounds are well documented. The feasibility of initiating automated insulin delivery (AID) soon after diagnosis of T1D is less certain in this population. This pilot study assessed the feasibility and acceptability of providing access to the Tandem Control-IQ AID system to children with public insurance soon after T1D diagnosis.

Publicly insured children aged 6–21 years of age within 3 months of T1D diagnosis were eligible for the study. Participants were randomized 2:1 to AID or usual care for 6 months. Continuous glucose monitoring data were collected at baseline, 3 months, and 6 months. Caregivers and youth completed closing surveys and participated in focus group interviews to assess safety and user experience.

Nineteen youth were enrolled, with thirteen in the intervention and six in the control group. The mean age was 11.5 ± 2.3 years, 47% were female, and 89% were from underrepresented racial or ethnic groups. A larger proportion of the AID group compared to the control group achieved the American Diabetes Association benchmark of > 70% time in range (50% vs. 0% of participants at 3 months; 37% vs. 0% of participants at 6 months; not statistically significant). All caregivers and 69% of youth in the AID group reported satisfaction, and 85% of youth continued using AID 6 months after the completion of the study. Focus groups showed favorable experiences with AID use.

Early initiation of AID is feasible and acceptable in youth with recently diagnosed T1D from underresourced populations who historically experience lower technology adoption and less optimal glycemic outcomes. Diabetes clinicians should consider providing tailored support and dedicated resources to families early in diagnosis with T1D to promote AID initiation and continued use.

Figures