SUN-192 - Impact of Sociodemographic Factors on Glycemic Control Among Type 1 Diabetes Patients at an Urban U.S. Pediatric Endocrinology Center

Background: Hemoglobin A1C of children with type 1 diabetes improves with the use of diabetes technologies such as insulin pumps. There are opportunities to reduce disparities in care by improving access to these technologies.

Objective: The purpose of this research is to conduct a retrospective cohort study on patients with type 1 diabetes seen by pediatric endocrinologists at Mass General for Children (MGfC) to evaluate whether certain demographic or socioeconomic factors influence the use of diabetes technologies and outcomes.

Methods: Data was extracted from the Epic Electronic Health Record (EHR) of 458 patients with type 1 diabetes seen by pediatric endocrinologists at MGfC from January 2015 to March 2025. Variables extracted from the data through the Research Patient Data Registry and manual chart review included age, sex, preferred language, race/ethnicity, BMI, HbA1c, time in range, number of inpatient diabetes admissions after diagnosis (excluding admissions during which they were diagnosed with diabetes), insurance type, pump class date, and pump start date. A 2-tailed t-test was used to compare statistical differences in mean HbA1c data between groups within the cohort.

Cohort Characteristics: 75.1% of patients in the cohort had an insulin pump and 24.9% did not. 88.9% of patients preferred the English language, 4.4% preferred Portuguese-Brazilian, and 4.1% preferred Spanish. 35.2% of patients had solely a public insurance plan, and 59.2% had solely a private insurance plan. 77.3% of patients never required inpatient admission following diagnosis, 13.5% required 1 admission, 4.8% required 2 admissions, and 4.4% required 3 or more admissions.

Results: Patients within our cohort who used an insulin pump had lower mean HbA1c compared to those who did not use an insulin pump (8.1 vs 9.3; p< 0.0001). Patients who identified their preferred language as English had a lower mean HbA1c compared to patients who identified a different preferred language (8.0 vs 9.0; p = 0.001). Those with a private insurance plan had a lower mean HbA1c than those with a public insurance plan (7.9 vs 9.1; p< 0.0001). There was a greater difference in mean HbA1c between patients on public insurance plans with or without pumps (8.6 vs 9.9; p < 0.0001) compared to between patients on private insurance plans (7.8 vs 8.6; p < 0.001).

Conclusion: Among pediatric endocrinology patients with type 1 diabetes at an urban U.S. medical center, access to insulin pump technology is associated with significantly lower HbA1c. This difference is greater for patients on public insurance plans compared to those on private insurance plans, suggesting that pumps have a greater impact on improving glycemic control for patients on public insurance plans compared to those on private insurance plans. Our data show that children with type 1 diabetes with barriers to health care access may benefit most from adoption of diabetes care technologies.

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