Initiating Insulin Pumps in Youth with New-onset Type 1 Diabetes: A Quality Improvement Initiative

Introduction:Insulin pump therapy is recommended for youth with type 1 diabetes (T1D) as it enhances quality of life and improves glycemic management. We led a quality improvement initiative to increase insulin pump use in youth younger than 18 years of age with recently diagnosed T1D (duration <1 y) from a baseline of 17% to 27% from January 2021 to December 2023. As a balancing measure, we evaluated the diabetes-related ketoacidosis (DKA) rate in the same cohort as nonpump users. Methods:We implemented the following plan-do-study-act cycles: (1) development and implementation of pump initiation algorithm, including minimal safe start criteria and education on ketosis management with pump action plan, (2) establishing clinic follow-up within 90 days of pump start, (3) expansion of the pump algorithm at additional clinic locations, (4) early patient/caregiver education about pumps at a clinic visit 2 weeks after diagnosis, and (5) insulin pump therapy workshop for staff and providers. Results:There was a centerline shift in the percentage of patients with recently diagnosed T1D on insulin pumps from 17% to 28% from January 2021 to December 2023. We also found no pumps-related DKA encounters amongst patients with recently diagnosed T1D. Conclusions:Our improvement efforts increased pump usage in our cohort without related DKA events. A multidisciplinary approach with education on managing pumps should be implemented to prevent shortcomings such as DKA. Future directions are to evaluate HbA1c and pre-pump and post-pump DKA rates.