ABSTRACT Aims In Ontario, publicly funded insulin pump therapy has been available to children with Type 1 diabetes since 2006. Before 31 March 2022, eligibility required three Haemoglobin A1c (A1C) measurements in the preceding year, with the two most recent < 10%. On 1 April 2022, this criterion was removed. We assessed whether this policy change reduced socioeconomic disparities in pump access among new applicants. Materials and Methods We conducted a population‐based retrospective cohort study including all children in Ontario who applied for insulin pump funding from program inception to 31 March 2024. The primary exposure was the time period (pre‐ vs. post‐policy change). The outcome was social disadvantage, measured using a five‐level neighbourhood index. Ordinal logistic regression with generalised estimating equations (accounting for neighbourhood clustering) estimated the odds of greater disadvantage post‐policy, adjusting for age, sex and diabetes duration. Segmented regression assessed changes over time in differences in application proportions between the most and least disadvantaged quintiles. Results A total of 7540 children applied pre‐policy and 1311 post‐policy. The mean A1C at application was similar between time periods (8.5% vs. 8.3%, p = 0.0002). Adjusted odds of greater disadvantage were higher post‐policy (OR: 1.32, 95% CI: 1.18–1.47). The difference in applications between the most versus least disadvantaged quintile decreased by 0.13%/quarter (95% CI: −0.22 to −0.05) pre‐policy and by 1.64%/quarter (95% CI: −8.3 to 5.0) post‐policy, though the pre versus post‐policy difference was not statistically significant ( p = 0.1). Conclusions Removal of A1C‐based eligibility may improve equity in paediatric insulin pump access, though longer follow‐up is needed.
Weisman et al. (Thu,) studied this question.