{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T19:13:02Z","timestamp":1781118782431,"version":"3.54.1"},"reference-count":33,"publisher":"American Diabetes Association","issue":"3","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100007028","name":"Leona M. and Harry B. Helmsley Charitable Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007028","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Diabetes technology, including insulin pumps, is associated with improved outcomes in youth with type 1 diabetes (T1D). However, youth with public insurance consistently demonstrate lower use. In 2022, we launched a quality improvement (QI) initiative to address disparities in insulin pump use among publicly insured youth with T1D. Our initial aim was to increase pump use from 30% to 40% within 15 months. We now report sustained and expanded outcomes, with pump use reaching 73% by December 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>Using a T1D-specific dashboard embedded within the electronic health record (EHR), we tracked monthly insulin pump use among publicly insured patients seen in our outpatient diabetes clinic. A multidisciplinary team designed and tested interventions through iterative plan-do-study-act cycles. Interventions included multilingual virtual and in-person insulin pump education classes, individualized one-on-one education sessions, Spanish-language educational materials, expanded class availability, targeted care navigation outreach to support scheduling and follow-up, provider implicit bias training, integration of pump screening questions into clinic intake workflows, and systematic collection of patient and family feedback through post\u2013insulin pump class evaluations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Insulin pump use increased from 30% in April 2022 to 42% by June 2023, and further to 73% by December 2025, reflecting sustained improvement and successful scale-up over a 44-month period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>An equity-centered, EHR-informed QI approach led to durable improvements in insulin pump use among publicly insured youth with T1D. These results demonstrate the potential for scalable, systems-based interventions to reduce disparities in diabetes technology access.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/doc26-0006","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T15:51:21Z","timestamp":1775749881000},"page":"343-349","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["Transforming Access: Empowering Publicly Insured Patients With Equitable Insulin Pump Therapy"],"prefix":"10.2337","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8523-9082","authenticated-orcid":false,"given":"Anna","family":"Cymbaluk","sequence":"first","affiliation":[{"name":"Rady Children\u2019s Hospital 1 , San Diego, CA"},{"name":"University of California, San Diego 2 , La Jolla, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christy","family":"Byer-Mendoza","sequence":"additional","affiliation":[{"name":"Rady Children\u2019s Hospital 1 , San Diego, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"McNamara","sequence":"additional","affiliation":[{"name":"Rady Children\u2019s Hospital 1 , San Diego, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Huber","sequence":"additional","affiliation":[{"name":"Rady Children\u2019s Hospital 1 , San Diego, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Dale","sequence":"additional","affiliation":[{"name":"Rady Children\u2019s Hospital 1 , San Diego, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"Garcellano","sequence":"additional","affiliation":[{"name":"Rady Children\u2019s Hospital 1 , San Diego, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Parker","sequence":"additional","affiliation":[{"name":"Rady Children\u2019s Hospital 1 , San Diego, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4538-0628","authenticated-orcid":false,"given":"Ori","family":"Odugbesan","sequence":"additional","affiliation":[{"name":"T1D Exchange 3 , Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1140-644X","authenticated-orcid":false,"given":"Carla","family":"Demeterco-Berggren","sequence":"additional","affiliation":[{"name":"Rady Children\u2019s Hospital 1 , San Diego, CA"},{"name":"University of California, San Diego 2 , La Jolla, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"2026061014523726500_B1","first-page":"CD005103","article-title":"Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus","volume":"2010","author":"Misso","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"2026061014523726500_B2","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1001\/jamapediatrics.2021.3965","article-title":"Effect of a hybrid closed-loop system on glycemic and psychosocial outcomes in children and adolescents with type 1 diabetes: a randomized clinical trial","volume":"175","author":"Abraham","year":"2021","journal-title":"JAMA Pediatr"},{"key":"2026061014523726500_B3","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1007\/s00592-019-01326-5","article-title":"Continuous subcutaneous insulin infusion vs modern multiple injection regimens in type 1 diabetes: an updated meta-analysis of randomized clinical trials","volume":"56","author":"Pala","year":"2019","journal-title":"Acta Diabetol"},{"key":"2026061014523726500_B4","doi-asserted-by":"crossref","first-page":"194","DOI":"10.2337\/ds18-0091","article-title":"A clinical overview of insulin pump therapy for the management of diabetes: past, present, and future of intensive therapy","volume":"32","author":"Berget","year":"2019","journal-title":"Diabetes Spectr"},{"key":"2026061014523726500_B5","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1177\/193229681200600428","article-title":"Insulin delivery device technology 2012: where are we after 90 years?","volume":"6","author":"Fry","year":"2012","journal-title":"J Diabetes Sci Technol"},{"key":"2026061014523726500_B6","doi-asserted-by":"crossref","first-page":"27","DOI":"10.2337\/dc12-0720","article-title":"Insulin regimens and clinical outcomes in a type 1 diabetes cohort: the SEARCH for Diabetes in Youth study","volume":"36","author":"Pihoker","year":"2013","journal-title":"Diabetes Care"},{"key":"2026061014523726500_B7","doi-asserted-by":"crossref","first-page":"S150","DOI":"10.2337\/dc26-S007","article-title":"7. 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