Increasing Insulin Pump Use in Youth with Type 1 Diabetes While Addressing Disparities

Abstract

Introduction: Automated insulin delivery is recommended for youth with type 1 diabetes (T1D). We aimed to increase the percentage of youth with T1D (diagnosed > 1 y) in 1 pediatric health system actively using an insulin pump from 56% to 65% within 18 months while reducing disparities based on race/ethnicity and insurance type. Methods: Following the Model for Improvement, local stakeholders organized this quality improvement project, identified a theory of change, and tested change ideas using the plan-do-study-act framework. We evaluated the primary outcome with a statistical process control chart, secondary outcomes with run charts, and other measures with descriptive statistics. Results: Between February 2024 and August 2025, insulin pump use increased from 56% to 65%, but disparities by race/ethnicity and insurance type persisted. Time from insulin pump education to initiation decreased by 19.8 days for patients who attended a group technology class. Non-face-to-face encounter volume decreased from 938 to 862 encounters per month, and diabetes-associated ketoacidosis events remained stable at 2% per month. Conclusions: This initiative increased insulin pump use among both reference and minoritized groups of youth with T1D at a single institution and improved the efficiency of the insulin pump initiation process without a measurable increase in workload or diabetes-associated ketoacidosis events. Although increased pump adoption among both groups is encouraging, continued advocacy at the individual and policy levels is needed to achieve optimal pump use and reduce disparities.