Background: Insulin pump use is known to improve glycemic control in patients with type 1 diabetes (T1D), however, uptake of insulin pump varies among people in U.S. This study aims to examine the distribution of patient demographics and frequency of clinical outcomes across people using insulin pump.

Methods: The analysis included 21,821 T1D patients in the T1D Exchange Quality Improvement (T1DX-QI) database for whom electronic medical record data was available in the T1DX-QI collaborative. Patients over 2 years with at least one completed clinic encounter between January 2014 – February 2020 were included for analysis.

Results: In this population, 58% (N=12,729) of T1D patients were insulin pump users, whereas 42% (N=9,092) were non-users. HbA1c levels in the insulin pump group were lower compared to non- users (Mean [SD], %: 8.5 [2.6] vs. 8.9[2.1] [p<0.001]). Events of severe hypoglycemia (4% vs.10%) and diabetic ketoacidosis (2% vs. 8%) were less frequently recorded for insulin pump users relative to the non-users [p<0.001].

Conclusions: This study highlights inequities in uptake of insulin pump therapy, while confirming previous findings demonstrating the use of insulin pump in combination with CGMs to be critical in effective management of blood glucose levels in one of the largest multi-center observational studies in the U.S.

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