Wheeler Benjamin J, Braund Rhiannon, Galland Barbara, Mikuscheva Anastasia, Wiltshire Esko, Jefferies Craig, de Lange Michel
Paediatric Endocrinology, Southern District Health Board, Dunedin; Department of Women's and Children's Health, University of Otago, Dunedin.
NZ Pharmacovigilance Centre, Preventive and Social Medicine, University of Otago, Dunedin.
N Z Med J. 2019 Mar 8;132(1491):78-89.
Insulin pump therapy (CSII) is becoming increasingly common for those living with type 1 diabetes (T1D), and has been publicly funded in New Zealand since 2012. The aim of the current study was to examine national uptake of publicly funded pumps from 2012 to 2016, with a focus on the proportion of patients using pumps analysed according to district health board (DHB) as well as demographic characteristics.
Data from nationally held data collections including the New Zealand Virtual Diabetes Register were used to calculate the overall and subgroup proportions using pumps. Logistic regression analysis was then used to estimate the independent contributions of DHB of residence and sociodemographic characteristics to variations in pump use.
Between 2012 and 2016, CSII for those living with T1D (n=17,338) increased from 1.6 to 11.3% overall. However, speed of uptake differed by DHB of residence, ethnicity, degree of deprivation, age and gender. A four-fold difference in uptake between highest and lowest using DHBs was seen after adjusting for known confounders.
From 2012 to 2016 there has been a steadily increasing uptake of CSII. Despite publicly funded access, disparities in use appear to exist, including by DHB of residence as well as traditionally described socio-demographic barriers to healthcare. Efforts to understand and reduce these disparities are required.
胰岛素泵治疗（持续皮下胰岛素输注，CSII）在1型糖尿病（T1D）患者中越来越普遍，自2012年起在新西兰已纳入公共资助范围。本研究的目的是调查2012年至2016年期间公共资助胰岛素泵的全国使用情况，重点是根据地区卫生委员会（DHB）以及人口统计学特征分析使用胰岛素泵的患者比例。
使用来自全国性数据收集（包括新西兰虚拟糖尿病登记册）的数据来计算使用胰岛素泵的总体和亚组比例。然后使用逻辑回归分析来估计居住地区卫生委员会和社会人口统计学特征对胰岛素泵使用差异的独立影响。
2012年至2016年期间，T1D患者（n = 17,338）中CSII的总体使用率从1.6%上升至11.3%。然而，使用率的增长速度因居住地区卫生委员会、种族、贫困程度、年龄和性别而异。在调整已知混杂因素后，使用胰岛素泵比例最高和最低的地区卫生委员会之间存在四倍的差异。
2012年至2016年期间，CSII的使用率稳步上升。尽管有公共资助，但在使用方面似乎存在差异，包括居住地区卫生委员会以及传统上描述的医疗保健社会人口学障碍。需要努力了解并减少这些差异。
