Attitudes and Practices of Youth and Young Adults with Type 1 Diabetes Towards Self-Adjustments of Insulin Pump Settings

Introduction: Achieving and maintaining glucose levels within recommended target range in individuals with Type 1 Diabetes (T1D) receiving insulin therapy requires frequent adjustments. However, routine clinic visits occur quarterly, and the extent and effectiveness of interim self-management among pediatric pump users remain insufficiently characterized. This study aimed to evaluate the frequency and practices of insulin pump self-adjustments among pediatric non- automated pump users and to examine their association with glycemic outcomes. Methods: We conducted a cross-sectional retrospective survey at Schneider Children's Medical Center of Israel between January 2019 and January 2023. The survey included 15 questions assessing self-management behaviors, pump parameter modifications, and attitudes toward automated decision support. Results: Seventy-five children, adolescents, and young adults (56% female) completed the questionnaire.; with a mean age of 15.5 ± 5.7 years, median HbA1c of 7.5 % (IQR 6.9, 8.6), and median daily insulin dose of 0.76 units/kg (0.6, 0.9). Forty percent of participants reported never independently adjusting insulin doses between clinical encounters, and 33.3% reported doing so rarely (1-2 times yearly). Basal rate was the most frequently modified parameter (93.8%). Engagement in self-adjustment was associated with lower HbA1c levels, and greater adjustment frequency correlated with glucose levels closer to target (rs = −0.389, p < 0.001). Sixty-nine percent expressed willingness to use automated insulin adjustment recommendations. Conclusions: Independent insulin pump adjustments between clinic visits were associated with HbA1c levels closer to recommended targets. These findings underscore the importance of strengthening patient education and structured support for interim diabetes self-management. Decision support tools and proactive provider guidance between visits may facilitate sustained glycemic optimization.