264-OR: Incorporating Shared Decision-Making to Facilitate Equitable Insulin Pump Use among Pediatric Patients with Type 1 Diabetes

Abstract

Background: Insulin pumps, CGMs, and other technologies have shown to improve outcomes for patients with T1D. However, various obstacles prevent some patient groups from utilizing these technologies. This was evident by the discrepancy in non-Hispanic black patients on insulin pumps (9%) vs non-Hispanic white patients (23%) in our clinic. Our goal is to identify and overcome these obstacles in order to safely increase the total number of patients that utilize insulin pumps while also creating equity in pump use between groups. Methods: We identified a group of non-Hispanic black patients who were not candidates for starting insulin pumps based on our clinic’s “typical” practice, but showed interest in pumps. By focusing on this group, we continued to adjust pump prescriptions and processes. After demonstrating efficacy and safety of pump use in this group, we began expanding to all patients as appropriate. Beyond continued education for nurse educators and changing pump start criteria, we also started using shared decision-making to be sure all patients were learning about technology on a regular basis. Results: As of December 2022, we have helped >35% of our interested patients navigate the process of obtaining an insulin pump. Equity was also improved, with 20% of our non-Hispanic black patients now using pumps vs 25% of non-Hispanic white patients. Some of these patients would not typically be candidates for pumps but were able to safely begin using this technology because of the interventions we initiated. Conclusions: Utilizing shared decision-making can help to identify patients who might not initially be considered for insulin pumps and other technology. We have demonstrated that many interested patients can safely initiate pumps which will help improve management of their diabetes. We are continually adjusting our processes to improve equity in pump use and increase the overall number of patients utilizing pumps in our clinic. Disclosure J.Turner: None. G.Nelson: None. B.V.Adams: None.