Shulman Rayzel, Stukel Therese A, Miller Fiona A, Newman Alice, Daneman Denis, Guttmann Astrid
Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.
Pediatr Diabetes. 2017 Feb;18(1):33-44. doi: 10.1111/pedi.12353. Epub 2016 Jan 8.
To describe insulin pump use by youth since introduction of universal funding in Ontario, Canada and to explore the relationship between pump use and pediatric diabetes center characteristics and the relationship between discontinuation and center and patient characteristics.
Observational, population-based cohort study of youth with type 1 diabetes (<19 yr) who received pump funding from 2006 to 2013 (n = 3700). We linked 2012 survey data from 33 pediatric diabetes centers to health administrative databases. We tested the relationship between center-level pump uptake and center characteristics (center type, physician model, and availability of 24-h support) using an adjusted negative binomial model; we studied center- and patient-level factors (socioeconomic status and baseline glycemic control) associated with discontinuation using a Cox proportional hazards model with generalized estimating equations.
Pump users were more likely to be in the highest income quintile than non-pump users (29.6 vs. 19.1%, p < 0.0001). In 2012, mean percent pump use was 38.0% with variability across centers. There was no association between uptake and center characteristics. Discontinuation was low (0.42/100 person-yr) and was associated with being followed at a small community center [hazard ratio (HR): 2.24 (1.05-4.76)] and being more deprived [HR: 2.36 (1.14-1.48)]. Older age was associated with a lower rate of discontinuation [HR: 0.31 (0.14-0.66)].
Rates of pump use have increased since 2006 and discontinuation is rare. Large variation in uptake across centers was not explained by the factors we examined but may reflect variation in patient populations or practice patterns, and should be further explored.
描述自加拿大安大略省实行胰岛素泵普及资助以来青少年对胰岛素泵的使用情况，并探讨胰岛素泵使用与儿科糖尿病中心特征之间的关系，以及停用胰岛素泵与中心和患者特征之间的关系。
对2006年至2013年接受胰岛素泵资助的1型糖尿病青少年（<19岁）进行基于人群的观察性队列研究（n = 3700）。我们将来自33个儿科糖尿病中心的2012年调查数据与卫生管理数据库相链接。我们使用调整后的负二项式模型测试中心层面胰岛素泵的使用率与中心特征（中心类型、医生模式和24小时支持的可用性）之间的关系；我们使用具有广义估计方程的Cox比例风险模型研究与停用胰岛素泵相关的中心和患者层面因素（社会经济状况和基线血糖控制）。
与未使用胰岛素泵的用户相比，使用胰岛素泵的用户更有可能处于最高收入五分位数（29.6%对19.1%，p < 0.0001）。2012年，胰岛素泵的平均使用率为38.0%，各中心之间存在差异。使用率与中心特征之间没有关联。停用率较低（0.42/100人年），并且与在小型社区中心接受随访[风险比（HR）：2.24（1.05 - 4.76）]以及贫困程度更高[HR：2.36（1.14 - 1.48）]相关。年龄较大与较低的停用率相关[HR：0.31（0.14 - 0.66）]。
自2006年以来胰岛素泵的使用率有所提高，停用情况很少见。我们所研究的因素未能解释各中心在使用率上的巨大差异，这可能反映了患者群体或实践模式的差异，应进一步探索。
