Insulin pumps have been publically funded in New Zealand since 2012 for patients who meet certain clinical criteria; however, the patterns of utilization have not been described. We undertook a nationwide study to estimate the annual proportions of patients with type 1 diabetes mellitus who used a pump between 2012 and 2014, overall, and according to sex, age, ethnicity, socioeconomic position, and region.
We used data from the New Zealand Virtual Diabetes Register and routinely collected national demographic, health, and pharmaceutical dispensing data from the Ministry of Health to identify patients with type 1 diabetes and to calculate the overall, and subgroup, proportions using pumps.
Between 2012 and 2014, funded pump use among patients with type 1 diabetes (n = 13,727) increased from 1.8 to 9.3 % overall; however, there were differences in uptake according to demographic characteristics and region. In 2014, proportionate pump use was significantly higher in females versus males (adjusted odds ratio (OR) 2.0 [95 % confidence interval 1.8–2.3]), in those aged <20 years, and in some regions. Māori (indigenous people), Pacific, and Asian patients were significantly less likely to use pumps than New Zealand Europeans (ORs 0.30 [0.23–0.41], 0.26 [0.14–0.46], 0.22 [0.14–0.35], respectively), as were those in the most versus the least deprived socioeconomic decile (OR 0.36 [0.25–0.52]).
It is essential to explore the factors driving differential insulin pump uptake, in both New Zealand and elsewhere, if all patients are to have equal opportunity to benefit from intensive diabetes management.
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Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Eng J Med 329:977–986
Diabetes Control and Complications Trial Research Group (1994) Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: diabetes control and complications trial. J Pediatr 125:177–188
Gubitosi-Klug RA, DCCT/EDIC Research Group (2014) The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: summary and future directions. Diabetes Care 37:44–49
Fullerton B, Jeitler K, Seitz M, Horvath K, Berghold A, Siebenhofer A (2014) Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus. Cochrane Database Syst Rev 2:CD009122
Atkinson MA, Eisenbarth GS, Michels AW (2014) Type 1 diabetes. Lancet 383:69–82
Cameron FJ, Wherrett DK (2015) Care of diabetes in children and adolescents: controversies, changes, and consensus. Lancet 385:2096–2106
Zuijdwijk CS, Cuerden M, Mahmud FH (2013) Social determinants of health on glycemic control in pediatric type 1 diabetes. J Pediatr 162:730–735
Senniappan S, Hine P, Tang W, Campbell J, Bone M, Sankar V, Robinson M, Smith C, Cooper C, Amin R, North West England Paediatric Diabetes Network (2012) The effect of socioeconomic deprivation on efficacy of continuous subcutaneous insulin infusion: a retrospective paediatric case-controlled survey. Eur J Pediatr 171:59–65
PHARMAC (2016) Insulin pumps and consumables special authority criteria. http://www.pharmac.govt.nz/2012/08/31/Insulin_pumps_and_consumables_SA_criteria.pdf. Accessed 24 May 2016
de Bock M, Gunn AJ, Holt JA, Derraik JG, Reed P, Cutfield W, Mouat F, Hofman P, Jefferies C (2012) Impact of insulin pumps on glycaemic control in a pump-naive paediatric regional population. J Paediatr Child Health 48:247–252
Carter PJ, Cutfield WS, Hofman PL, Gunn AJ, Wilson DA, Reed PW, Jefferies C (2008) Ethnicity and social deprivation independently influence metabolic control in children with type 1 diabetes. Diabetologia 51:1835–1842
Statistics New Zealand (2016) National population estimates: at 30 June 2015 http://www.stats.govt.nz/browse_for_stats/population/estimates_and_projections/NationalPopulationEstimates_HOTPAt30Jun15.aspx. Accessed 5 June 2016
Ministry of Health: National Collections. http://www.health.govt.nz/nz-health-statistics/national-collections-and-surveys/collections. Accessed 24 May 2016
Ministry of Health: National Health Index. http://www.health.govt.nz/our-work/health-identity/national-health-index. Accessed 24 May 2016
Ministry of Health: National Minimum Dataset (hospital events). http://www.health.govt.nz/nz-health-statistics/national-collections-and-surveys/collections/national-minimum-dataset-hospital-events. Accessed 24 May 2016
Ministry of Health: Mortality Collection. http://www.health.govt.nz/nz-health-statistics/national-collections-and-surveys/collections/mortality-collection. Accessed 24 May 2016
Pharmaceutical Collection (2016) http://www.health.govt.nz/nz-health-statistics/national-collections-and-surveys/collections/pharmaceutical-collection. Accessed 24 May 2016
Ministry of Health: Virtual diabetes register. http://www.health.govt.nz/our-work/diseases-and-conditions/diabetes/about-diabetes/virtual-diabetes-register-vdr. Accessed 24 May 2016
Jo EC, Drury PL (2015) Development of a Virtual Diabetes Register using Information Technology in New Zealand. Healthc Inf Res 21:49–55
Ministry of Health (2004) Ethnicity data protocols for the health and disability sector. Ministry of Health, Wellington
Salmond C, Crampton P, Atkinson J (2007) NZDep2006 Index of deprivation user’s manual. University of Otago, Wellington
Ministry of Health: District Health Boards. http://www.health.govt.nz/new-zealand-health-system/key-health-sector-organisations-and-people/district-health-boards. Accessed 24 May 2016
StataCorp: Stata Statistical Software (2013) Release 13. College Station, TX: StataCorp LP
Blank ML, Parkin L, Paul C, Herbison P (2014) A nationwide nested case-control study indicates an increased risk of acute interstitial nephritis with proton pump inhibitor use. Kidney Int 86:837–844
Parkin L, Paul C, Herbison GP (2014) Simvastatin dose and risk of rhabdomyolysis: nested case-control study based on national health and drug dispensing data. Int J Cardiol 174:83–89
Ministry of Health (2015) Annual Update of Key Results 2014/15: New Zealand Health Survey. Adult data tables: health status, health behaviours and risk factors. http://www.health.govt.nz/publication/annual-update-key-results-2014-15-new-zealand-health-survey. Ministry of Health, Wellington
Tomlin A, Tilyard M, Dawson A, Dovey S (2006) Health status of New Zealand European, Maori, and Pacific patients with diabetes at 242 New Zealand general practices. N Z Med J 119:U2004
Bonfanti R, Lepore G, Bozzetto L, Corsi A, Di Blasi V, Girelli A, Grassi G, Iafusco D, Rabbone I, Schiaffini R, Laviola L, Bruttomesso D (2016) Survey on the use of insulin pumps in Italy: comparison between pediatric and adult age groups (IMITA study). Acta Diabetol 53:403–412
Thompson RJ, Agostini K, Potts L, Luscombe J, Christie D, Viner R, White B, Hindmarsh PC (2013) Deprivation and ethnicity impact on diabetes control and use of treatment regimen. Diabet Med 30:491–494
Paris CA, Imperatore G, Klingensmith G, Petitti D, Rodriguez B, Anderson AM, Schwartz ID, Standiford DA, Pihoker C (2009) Predictors of insulin regimens and impact on outcomes in youth with type 1 diabetes: the SEARCH for Diabetes in Youth Study. J Pediatr 151:183–189
Willi SM, Miller KM, DiMeglio LA, Klingensmith GJ, Simmons JH, Tamborlane WV, Nadeau KJ, Kittelsrud JM, Huckfeldt P, Beck RW, Lipman TH, T1 D Exchange Clinic Network, (2015) Racial-ethnic disparities in management and outcomes among children with type 1 diabetes. Pediatrics 135:424–434
Icks A, Razum O, Rosenbauer J, Bachle C, Hungele A, Monkemoller K, Muller-Godeffroy E, Heidtmann B, Kapellen T, Scheuing N, Holl RW (2012) Lower frequency of insulin pump treatment in children and adolescents of Turkish background with type 1 diabetes: analysis of 21,497 patients in Germany. Diabetes Technol Ther 14:1105–1109
Scheuing N, Wiegand S, Bachle C, Frohlich-Reiterer E, Hahn E, Icks A, Ludwig KH, Monkemoller K, Razum O, Rosenbauer J, Holl RW, DPV initiative (2015) Impact of maternal country of birth on type 1 diabetes therapy and outcome in 27,643 children and adolescents from the DPV Registry. PLoS One 10:e0135178
Hine P, Senniappan S, Sankar V, Amin R (2011) Deprivation impedes success of insulin intensification in children and adolescents with Type 1 diabetes; longitudinal linear mixed modelling of a retrospective observational cohort. Diabet Med 28:338–344
We thank Analytical Services at the Ministry of Health for providing the data for this study.
This research was funded through a Strategic Initiative Award from Health Research South, Dunedin School of Medicine, University of Otago. EM received support through an Otago Medical Research Fund and Kelliher Charitable Trust Summer Scholarship Award. The funders had no role in the design of the study, or in the collection, analysis, or interpretation of the data.
EM contributed to the design of the study, carried out the main analyses, interpreted the findings, and co-wrote the first draft of the manuscript. LP conceived and designed the study, obtained funding, acquired the data, specified the analyses, interpreted the findings, co-wrote the first draft of the manuscript, and was responsible for final editing. DJB provided data management expertise, programmed the study algorithm, derived the analysis dataset, and contributed to critical revision of the manuscript. KJS provided statistical expertise, undertook the logistic regression analyses, contributed to the interpretation of the findings, and contributed to critical revision of the manuscript. BJW conceived the study, contributed to the design, interpreted the findings, and contributed to the first draft and critical revision of the manuscript.
Conflict of interest
BJW received a speaker fee from New Zealand Medical & Scientific Ltd in 2015. All other authors report no conflicts of interest.
Ethical approval was granted by the University of Otago Human Ethics Committee (Health), reference number D15/268.
Human and animal rights
This article does not contain any studies with human or animal subjects performed by the any of the authors.
This study was based on anonymised routinely collected data and therefore did not involve contact with patients.
Erin McKergow and Lianne Parkin shared equal authorship.
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McKergow, E., Parkin, L., Barson, D.J. et al. Demographic and regional disparities in insulin pump utilization in a setting of universal funding: a New Zealand nationwide study. Acta Diabetol 54, 63–71 (2017). https://doi.org/10.1007/s00592-016-0912-7
- Insulin pump
- Socioeconomic position