Purpose: To evaluate whether low-income pediatric patients with type-1 diabetes living in Massachusetts experience disparities in access to insulin pumps and if there are disparities, what are the root causes.

Methods: The first part of this study was a literature review to identify access disparities and any barriers experienced by the population. The second part of this study was interviewing stakeholders in Massachusetts who have insight on this topic. Stakeholders in this study are defined as experts who have an impact or interaction with the investigated population. A snowballing method of sampling method was used where stakeholders were asked to refer someone. The stakeholders consisted of physicians (33%), nurses/educators (33%), pump representatives/trainer (17%), and health insurance workers (17%). A transcription tool, NVivo™, was used to search for common themes among the interviews.

Results: Common barriers were identified as: economics, social factors, developmental stage, education level and patient-provider assessment. Economically, patients encountered unaffordable copays and extensive paperwork. Socially, patients feared embarrassment and admission of their diagnosis. Younger patients, usually children under an adolescent age, are commonly denied a pump due to the lack of management control and physical discomfort with pump attachment. Lack of education from guardians and/or patients operating a pump limited access and influenced opting out. Provider assessment of the patient’s glycemic control also determined pump access.

Conclusion: Findings from this study have confirmed that there is an access gap for this population in Massachusetts. Access to pumps have been found to be influenced by the following barriers: economics, social factors, developmental stage, education level and patient-provider assessment.


I. Bonetti: None. A.R. Segal: None. G. Marcus: None.


Massachusetts College of Pharmacy and Health Sciences

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.