{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T19:00:27Z","timestamp":1790362827467,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015521","name":"Stanford Maternal and Child Health Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015521","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Drivers of inequitable health outcomes are underexplored in minoritized youth with type 1 diabetes (T1D). In this pilot qualitative study, we recruited parents and guardians (hereafter referred to as caregivers) of youth with T1D on public insurance at Stanford Medicine Children's Health. We explore the reasons caregivers cited for lower uptake of insulin pumps as compared with continuous glucose monitoring (CGM) sensors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Caregivers (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200921, 39\u2009\u00b1\u20098\u2009years, youth age range 3\u201311\u2009years, 67% Hispanic, 48% Spanish\u2010speaking, 69% income &lt;$50 K) completed focus groups or interviews which were conducted, transcribed, and analysed in English (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20099) or Spanish (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20097), per caregiver preference. Transcripts were analysed deductively and inductively by a four\u2010member team that included three bilingual members.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      One prevailing and novel theme emerged:\n                      <jats:italic>CGM is a necessity, but an insulin pump is negotiable<\/jats:italic>\n                      , with three supporting sub\u2010themes: (1)\n                      <jats:italic>child preference<\/jats:italic>\n                      (e.g., body real estate); (2)\n                      <jats:italic>parental hesitancy<\/jats:italic>\n                      (e.g., pump mistrust); (3)\n                      <jats:italic>provider as gatekeeper<\/jats:italic>\n                      (e.g., CGM prioritized). The second and third themes identified were\n                      <jats:italic>insurance\u2010related barriers<\/jats:italic>\n                      and\n                      <jats:italic>language\u2010related barriers<\/jats:italic>\n                      (e.g., English manuals only). The final theme identified was\n                      <jats:italic>facilitators of pump use<\/jats:italic>\n                      (e.g., recommendation by provider).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Caregivers of youth with T1D and public insurance endorse the perception that CGM is a necessity over an insulin pump. Clinicians should be aware of this perception given the overwhelming evidence supporting that automated insulin delivery systems improve diabetes outcomes. These data further outline the importance of continued advocacy by clinicians, payers, and industry for equitable access to diabetes technology for all youth with T1D.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.70189","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T04:54:48Z","timestamp":1765428888000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["\u201cThe pump is one thing\u2026 but you should walk out of the hospital with a [sensor]\u201d: Perceptions on diabetes technology from minoritized caregivers in the\n                    <scp>US<\/scp>"],"prefix":"10.1111","volume":"43","author":[{"given":"Diana","family":"Pe\u00f1a","sequence":"first","affiliation":[{"name":"Department of Pediatrics Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Medina Pe\u00f1aranda","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Department of Pediatrics Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren E.","family":"Figg","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Department of Pediatrics Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Korey K.","family":"Hood","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Department of Pediatrics Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0508-4309","authenticated-orcid":false,"given":"Ananta","family":"Addala","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Department of Pediatrics Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2018.0384"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.13994"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/cd21-0028"},{"key":"e_1_2_11_5_1","unstructured":"7. Diabetes Technology: Standards of Care in Diabetes\u20142024 | Diabetes Care | American Diabetes Association. Accessed February 20 2024.https:\/\/diabetesjournals.org\/care\/article\/47\/Supplement_1\/S126\/153939\/7\u2010Diabetes\u2010Technology\u2010Standards\u2010of\u2010Care\u2010in?searchresult=1"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-0172"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.15906"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc23-0504"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2022.0201.pub"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1155\/2023\/8867625"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2022.0518"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2023.0123"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2022.0558"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc23-S014"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-018-1037-x"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa236"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-0257"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2022.100644"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-072546"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.13082"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-2753"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2021.0075"},{"key":"e_1_2_11_23_1","doi-asserted-by":"crossref","unstructured":"1167\u2010P: \u201cI don't know if I can call it discrimination but\u2026\u201d\u2014Perceived Discrimination in Provision of Pediatric Type 1 Diabetes (T1D) Care | Diabetes | American Diabetes Association. Accessed October 4 2024.https:\/\/diabetesjournals.org\/diabetes\/article\/72\/Supplement_1\/1167\u2010P\/149979\/1167\u2010P\u2010I\u2010don\u2010t\u2010know\u2010if\u2010I\u2010can\u2010call\u2010it","DOI":"10.2337\/db23-1167-P"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci20-0053"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/19322968211006476"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2022.0042"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci23-0057"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.8881"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab859"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-024-02975-y"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.2337\/cd23-0052"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/1753-0407.13235"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-1666"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1159\/000541774"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2024.111568"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.4159\/9780674028845"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1177\/109019818801500401"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2018.0174"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcdhc.2022.876511"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2022.110235"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1530\/EC-23-0193"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1177\/1932296819832909"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.14567"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.14923"},{"key":"e_1_2_11_45_1","unstructured":"Medicaid and CGM: Who's Covered? diaTribe. November 21 2019. Accessed September 24 2023.https:\/\/diatribe.org\/medicaid\u2010and\u2010cgm\u2010whos\u2010covered"},{"key":"e_1_2_11_46_1","unstructured":"Bureau UC.Nearly 68 million people spoke a language other than English at home in 2019. Censusgov. Accessed December 17 2022.https:\/\/www.census.gov\/library\/stories\/2022\/12\/languages\u2010we\u2010speak\u2010in\u2010united\u2010states.html"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2025.06.023"},{"key":"e_1_2_11_48_1","unstructured":"AddalaA.Improving outcomes in pediatric diabetes: building the evidence base to inform effective diabetes technology interventions. Clinicaltrialsgov.2025."}],"container-title":["Diabetic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.70189","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/dme.70189","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.70189","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T17:24:58Z","timestamp":1770657898000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dme.70189"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,10]]},"references-count":47,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1111\/dme.70189"],"URL":"https:\/\/doi.org\/10.1111\/dme.70189","archive":["Portico"],"relation":{},"ISSN":["0742-3071","1464-5491"],"issn-type":[{"value":"0742-3071","type":"print"},{"value":"1464-5491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,10]]},"assertion":[{"value":"2025-06-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70189"}}