{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:14:50Z","timestamp":1789172090408,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100010231","name":"Banting Research Foundation","doi-asserted-by":"publisher","award":["Discovery Award"],"award-info":[{"award-number":["Discovery Award"]}],"id":[{"id":"10.13039\/100010231","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100022210","name":"Canadian Statistical Sciences Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100022210","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>In Ontario, publicly funded insulin pump therapy has been available to children with Type 1 diabetes since 2006. Before 31 March 2022, eligibility required three Haemoglobin A1c (A1C) measurements in the preceding year, with the two most recent &lt;\u200910%. On 1 April 2022, this criterion was removed. We assessed whether this policy change reduced socioeconomic disparities in pump access among new applicants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We conducted a population\u2010based retrospective cohort study including all children in Ontario who applied for insulin pump funding from program inception to 31 March 2024. The primary exposure was the time period (pre\u2010 vs. post\u2010policy change). The outcome was social disadvantage, measured using a five\u2010level neighbourhood index. Ordinal logistic regression with generalised estimating equations (accounting for neighbourhood clustering) estimated the odds of greater disadvantage post\u2010policy, adjusting for age, sex and diabetes duration. Segmented regression assessed changes over time in differences in application proportions between the most and least disadvantaged quintiles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 7540 children applied pre\u2010policy and 1311 post\u2010policy. The mean A1C at application was similar between time periods (8.5% vs. 8.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0002). Adjusted odds of greater disadvantage were higher post\u2010policy (OR: 1.32, 95% CI: 1.18\u20131.47). The difference in applications between the most versus least disadvantaged quintile decreased by 0.13%\/quarter (95% CI: \u22120.22 to \u22120.05) pre\u2010policy and by 1.64%\/quarter (95% CI: \u22128.3 to 5.0) post\u2010policy, though the pre versus post\u2010policy difference was not statistically significant (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.1).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Removal of A1C\u2010based eligibility may improve equity in paediatric insulin pump access, though longer follow\u2010up is needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70901","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T01:52:06Z","timestamp":1780019526000},"page":"7039-7047","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Removing Restrictive Haemoglobin\n                    <scp>A1C<\/scp>\n                    Eligibility Criteria for Insulin Pump Therapy Funding for Children With Type 1 Diabetes in Ontario, Canada"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3778-653X","authenticated-orcid":false,"given":"Alanna","family":"Weisman","sequence":"first","affiliation":[{"name":"Lunenfeld\u2010Tanenbaum Research Institute, Mount Sinai Hospital  Toronto Ontario Canada"},{"name":"Division of Endocrinology and Metabolism, Department of Medicine University of Toronto  Toronto Ontario Canada"},{"name":"ICES  Toronto Ontario Canada"},{"name":"Temerty Faculty of Medicine University of Toronto  Toronto Ontario Canada"},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Everett","sequence":"additional","affiliation":[{"name":"ICES  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Austin","sequence":"additional","affiliation":[{"name":"ICES  Toronto Ontario Canada"},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rayzel","family":"Shulman","sequence":"additional","affiliation":[{"name":"ICES  Toronto Ontario Canada"},{"name":"Temerty Faculty of Medicine University of Toronto  Toronto Ontario Canada"},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto  Toronto Ontario 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