An equity-oriented analysis on using diabetes-related technology in children and adolescents with type 1 diabetes mellitus

Abstract

Optimal type 1 diabetes mellitus care requires lifelong appropriate intensive insulin treatment, which can be provided either by multiple-daily injections of insulin or by continuous subcutaneous insulin infusions (CSII). Although both therapies have shown to be effective to manage type 1 diabetes in children and adolescents, lately the CSII have gained ground over conventional treatment with syringes and pens. However, little is known on equity and fairness regarding access to the newest diabetes-related technologies, and whether the decision to start on these technologies is influenced by previous experience of healthcare professionals instead of recommendations from clinical guidelines. Moreover, uptake of these technologies may be affected by considerable differences in healthcare system coverage between countries, and individuals’ and families’ preferences. Therefore, this thesis aims to address issues on (i) the benefits of the newest diabetes devices on improving glycemic outcomes, (ii) the equity of starting the CSII among those who would benefit more, and (iii) the uptake of these technologies among providers by their decision-making on recommending to individuals with type 1 diabetes.