ESPE Abstracts

*Both authors contributed equally to this work

Background: Continuous Subcutaneous Insulin Infusions (CSII) or insulin pumps improve overall glycaemic control in paediatric populations. Children’s access to CSII may partly depend on socioeconomic status (SES), healthcare systems, and funding structures.

Aim: The aim of our systematic review was to evaluate whether SES affects children’s access to CSII, across various countries with different types of healthcare provision.

Methods: We searched MEDLINE for peer-reviewed articles published between 1st January 2002 and 5th April 2022. Search-term groups comprised ‘insulin pump / CSII’, ‘paediatric’, and ‘socioeconomic’. Neither language nor geographical restrictions were applied. Studies were eligible for inclusion when (1) all participants were under 21; (2) data on insulin pump access were available; and (3) SES data on participants having an insulin pump were provided. Two independent authors examined titles, abstracts, and studies. Results were corroborated. We extracted study design and location, data collection dates, number of participants on insulin pumps and not on insulin pumps (i.e. control group), SES measures used, relationship between SES and pump access, as well as whether insulin pumps were publicly funded. Individual study quality was assessed using an abbreviated and adapted version of the JBI Critical Appraisal Tools.

Results: Our search identified 203 studies of which 20 were included. Ten studies were classified as ‘high’, eight as ‘medium’, and two as ‘low’ quality. Participants on insulin pumps totalled 37,650 (34,661 in control groups). All data was collected between 2001 and 2019. Thirteen studies were conducted in North America, six in Europe and one in Oceania. Seven studies took place in countries with nationwide government-funded insulin pump programs. The main measures of SES were based on deprivation or equity indices, annual family income, parental education, and access to health insurance. Nineteen studies reported either lower insulin pump access among children from lower SES backgrounds or higher insulin pump access among children from higher SES backgrounds. One ‘medium’ quality study reported no difference in insulin pump access based on SES. One ‘low’ quality study reported lower proportion of insulin pump access among children from higher SES backgrounds.

Conclusion: Participants from lower SES backgrounds were less frequently on insulin pumps, regardless of the healthcare funding structure of their country. Other factors such as ethnicity and physician bias may also contribute to disparities in insulin pump access. Addressing these aspects may also contribute to better glycaemic control in paediatric populations.