2003-P: Association of Health Insurance Coverage Decisions with Glycemic Outcomes in People with Type 1 Diabetes Prescribed Automated Insulin Delivery

Introduction and Objective: Automated insulin delivery (AID) systems improve glycemic control in people with type 1 diabetes (PWT1D). Despite these benefits, access to AID systems in private healthcare settings is often limited by insurance coverage decisions. Here, we examined the impact of insurance coverage decisions for insulin pump therapy on clinical outcomes among PWT1D in Saudi Arabia Methods: A retrospective analysis of clinical data from 492 insured PWT1D who were prescribed an AID system by their treating endocrinologist at a private diabetes center in Saudi Arabia between January 2022 and February 2025 Results: Overall, 55% of participants were female. Insurance approval was granted for 44.1% of insulin pump requests, while 56% were denied. Participants whose pump requests were approved were younger than those denied (median age: 18 vs 26 years, p<0.01), had shorter diabetes duration (7.5 vs 11 years, p<0.01), and had greater baseline hemoglobin A1C levels (8.7 % vs 8.1, p<0.01). Among PWT1D with insurance approval who initiated AID therapy, hemoglobin A1C levels improved from baseline through months 3, 6, 12, and 16 (8.91, 7.57, 7.45, 7.86, 7.61%, respectively, overall p<0.05). In contrast, PWT1D whose pump requests were denied, and who did not initiate AID therapy, continued to have above-target A1C levels throughout follow-up (baseline to months 3, 6, 12, and 16: 8.62, 8.16, 8.02, 8.44, and 8.44%, respectively; overall p>0.05). After adjusting for age, gender, age at time of T1D diagnosis, baseline A1C, and baseline modality of T1D treatment, the likelihood of achieving an A1C level of <7% was significantly higher in the insurance-approved group compared to the denied group at both month 3 (OR: 4.22) and month 16 (OR:3.20) Conclusion: Insurance coverage decisions for AID therapy play a critical role in shaping long-term glycemic outcomes. Ensuring adequate insurance coverage for AID may improve clinical outcomes and help reduce the long-term financial burden on the healthcare system Disclosure M.E. Al-Sofiani: Speaker's Bureau; Ended; Medtronic, Dexcom, Inc. Research Support; Current; Dexcom, Inc. Research Support; Ended; Medtronic. Speaker's Bureau; Ended; Insulet Corporation, Abbott Diabetes, Sanofi. Y.A. Alzamil: None.