Everett Estelle, Dao Lisa, Munaganuru Nagambika, Udeze Kelechi, Gutierrez Samantha, Gann Sarah, Meda Ashley, Tiu Ryan, Arevalo Amanda, Drexler Chanelz, Abdulrahman Yonis, Santana Cynthia, Moin Tannaz
Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA.
Division of General Internal Medicine & Health Sciences Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA.
J Endocr Soc. 2025 Apr 18;9(7):bvaf068. doi: 10.1210/jendso/bvaf068. eCollection 2025 Jul.
We evaluated provider sentiments and practices that influence recommendations for insulin pump use.
We surveyed US adult endocrinologists and used descriptive statistics to assess guideline adherence and criteria for insulin pump candidacy. Providers were categorized as permissive or selective prescribers based on reliance on criteria outside of clinical guidelines. Adjusted logistic regression identified factors associated with selective prescribing.
In 2023, we emailed surveys to 5684 endocrinologists, and 299 (5%) responded. Criteria for insulin pump use varied across providers: carbohydrate counting (55%), a minimum number of daily glucose checks (51%), a minimum number of clinic visits (48%), continuous glucose monitor use (42%), a minimum duration after diagnosis (20%), and a specific A1c (8%). While 94% reported being aware of diabetes care guidelines, 52% almost never referenced guidelines when determining insulin pump candidacy. The majority reported relying on their own judgment about insulin pump candidacy when it conflicted with clinical guidelines. Selective prescribers were more likely to report using guidelines sometimes or more (vs not often/never), have a low proportion of diabetes in their clinical case mix, and see patients primarily with public insurance.
Less than half of endocrinologists referenced national guidelines for pump candidacy, with many relying on nonevidence-based criteria. These findings demonstrate an important disconnect between guideline recommendations and clinical practice that may lead to underutilization of insulin pumps, which can enhance diabetes care and outcomes. Additional work is needed to better align clinical practice with current recommendations.
我们评估了影响胰岛素泵使用推荐的医疗服务提供者的观点和做法。
我们对美国成年内分泌科医生进行了调查，并使用描述性统计方法来评估指南依从性和胰岛素泵候选标准。根据对临床指南以外标准的依赖程度，将医疗服务提供者分为宽松处方者或选择性处方者。调整后的逻辑回归分析确定了与选择性处方相关的因素。
2023年，我们向5684名内分泌科医生发送了电子邮件调查问卷，299人（5%）回复。胰岛素泵使用标准在不同医疗服务提供者之间存在差异：碳水化合物计数（55%）、每日最低血糖检测次数（51%）、最低门诊就诊次数（48%）、持续葡萄糖监测使用情况（42%）、诊断后最短时长（20%）以及特定糖化血红蛋白水平（8%）。虽然94%的人表示了解糖尿病护理指南，但52%的人在确定胰岛素泵候选资格时几乎从不参考指南。大多数人报告称，当与临床指南冲突时，他们依靠自己对胰岛素泵候选资格的判断。选择性处方者更有可能报告有时或更多地使用指南（与不常/从不使用相比），其临床病例组合中糖尿病患者比例较低，且主要诊治有公共保险的患者。
不到一半的内分泌科医生参考胰岛素泵候选资格的国家指南，许多人依赖非循证标准。这些发现表明指南推荐与临床实践之间存在重要脱节，这可能导致胰岛素泵使用不足，而胰岛素泵可改善糖尿病护理和治疗效果。需要开展更多工作，使临床实践更好地与当前推荐保持一致。
