Evidence mapPaperPMID 41588870Full record

ArticleDiabetes, obesity & metabolism2026

Timing of insulin pump initiation among individuals with type 1 diabetes in Ontario, Canada.

Xi Zhu, Lorraine L Lipscombe, Rayzel Shulman, Leif Erik Lovblom, Karl Everett, Alanna Weisman

Abstract read
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Article in Diabetes, obesity & metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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0cells of the map it votes in
1citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Xi ZhuTemerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Lorraine L LipscombeDepartment of Medicine, University of Toronto, Toronto, Ontario, Canada.
Rayzel ShulmanTemerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Leif Erik LovblomIHPME, University of Toronto, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0002-6774-8924
Karl EverettICES, Toronto, Ontario, Canada.
Alanna WeismanDepartment of Medicine, University of Toronto, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0003-3778-653X

Funding

Breakthrough T1D CanadaCIHRDiabetes Canada
6 · The paper itself

Abstract

aimsTo assess characteristics associated with earlier (≤2 years since diagnosis) versus later (>2 years) insulin pump initiation among new type 1 diabetes applicants to the publicly funded insulin pump program in Ontario, and whether timing of pump initiation is associated with cumulative glycaemic exposure. MATERIALS AND

methodsA retrospective population-based cohort study was conducted using administrative healthcare databases in Ontario, Canada. All pump program applicants prior to 31 March 2021 were included. An adjusted log-binomial regression model using generalized estimating equations assessed associations between patient- and physician-level characteristics and earlier versus later pump initiation. A linear regression model examined differences in cumulative HbA1c over time between earlier versus later pump initiators.

resultsAmong 4899 individuals, 62.6% were earlier pump initiators. Greater social disadvantage was associated with lower likelihood of earlier pump initiation [adjusted relative risk (RR) 0.81 (95% confidence interval {CI} 0.75-0.88)] for most versus least disadvantaged quintile. Compared to paediatrician care, endocrinologist [RR 0.85 (95% CI 0.79, 0.91)], general internist [0.73 (0.64-0.83)], and family physician care [0.28 (0.21-0.37)] were associated with less earlier pump initiation. Older age at diagnosis and physician training prior to publicly funded pump therapy were associated with less earlier pump initiation. Earlier pump initiators had a significantly lower annual rate of increase in cumulative HbA1c compared with later initiators (-0.33% per year; 95% CI -0.45 to -0.20; p < 0.001), although cumulative HbA1c at 10 years did not differ significantly between groups (mean difference -1.50; p = 0.112).

conclusionsSocial disadvantage and physician characteristics are associated with less earlier pump initiation, which may have negative long-term effects on glycaemic management. Barriers to earlier pump initiation should be removed to promote equitable access and optimize glycaemic outcomes.

Indexed as

Diabetes Mellitus, Type 1Hypoglycemic AgentsInsulinInsulin Infusion SystemsAdolescentAdultBlood GlucoseChildFemaleGlycated HemoglobinHumansMaleMiddle AgedOntarioRetrospective StudiesTime FactorsBlood GlucoseGlycated Hemoglobinhemoglobin A1c protein, humanHypoglycemic AgentsInsulinadministrative dataepidemiologyhealth disparitiesinsulin pumpstype 1 diabetes

Identifiers

PMID41588870
PMCPMC12992180

What Socratic holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.