{"id":24119,"date":"2026-05-28T16:28:52","date_gmt":"2026-05-28T20:28:52","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=24119"},"modified":"2026-05-29T16:32:04","modified_gmt":"2026-05-29T20:32:04","slug":"impact-of-removing-restrictive-haemoglobin-a1c-eligibility-criteria-for-insulin-pump-therapy-funding-for-children-with-type-1-diabetes-in-ontario-canada","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/impact-of-removing-restrictive-haemoglobin-a1c-eligibility-criteria-for-insulin-pump-therapy-funding-for-children-with-type-1-diabetes-in-ontario-canada\/","title":{"rendered":"Impact of removing restrictive haemoglobin A1C eligibility criteria for insulin pump therapy funding for children with type 1 diabetes in Ontario, Canada"},"content":{"rendered":"<p><strong>Aims<\/strong> \u2014 In Ontario, publicly funded insulin pump therapy has been available to children with Type 1 diabetes since 2006. Before 31 March 2022, eligibility required three Haemoglobin A1c (A1C) measurements in the preceding year, with the two most recent &lt;\u200910%. On 1 April 2022, this criterion was removed. We assessed whether this policy change reduced socioeconomic disparities in pump access among new applicants.<\/p>\n<p><strong>Materials and methods<\/strong> \u2014 We conducted a population-based retrospective cohort study including all children in Ontario who applied for insulin pump funding from program inception to 31 March 2024. The primary exposure was the time period (pre- vs. post-policy change). The outcome was social disadvantage, measured using a five-level neighbourhood index. Ordinal logistic regression with generalised estimating equations (accounting for neighbourhood clustering) estimated the odds of greater disadvantage post-policy, adjusting for age, sex and diabetes duration. Segmented regression assessed changes over time in differences in application proportions between the most and least disadvantaged quintiles.<\/p>\n<p><strong>Results<\/strong> \u2014 A total of 7540 children applied pre-policy and 1311 post-policy. The mean A1C at application was similar between time periods (8.5% vs. 8.3%, p\u2009=\u20090.0002). Adjusted odds of greater disadvantage were higher post-policy (OR: 1.32, 95% CI: 1.18\u20131.47). The difference in applications between the most versus least disadvantaged quintile decreased by 0.13%\/quarter (95% CI: \u22120.22 to \u22120.05) pre-policy and by 1.64%\/quarter (95% CI: \u22128.3 to 5.0) post-policy, though the pre versus post-policy difference was not statistically significant (p\u2009=\u20090.1).<\/p>\n<p><strong>Conclusions<\/strong> \u2014 Removal of A1C-based eligibility may improve equity in paediatric insulin pump access, though longer follow-up is needed.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Aims \u2014 In Ontario, publicly funded insulin pump therapy has been available to children with Type 1 diabetes since 2006. Before 31 March 2022, eligibility required three Haemoglobin A1c (A1C) measurements in the preceding year, with the two most recent &lt;\u200910%. On 1 April 2022, this criterion was removed. We assessed whether this policy change [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[50,61,35],"migration-helper-qa-sample-set":[],"class_list":["post-24119","journal_article","type-journal_article","status-publish","hentry","topic-endocrinology","topic-health-economics","topic-public-health"],"acf":{"citation":"Weisman A, Everett K, Austin PC, Shulman R. <em>Diabetes Obes Metab<\/em>. 2026; May 28 [Epub ahead of print].","source_url":"https:\/\/doi.org\/10.1111\/dom.70901","ices_scientist":[1125,1385,1352],"site":[6733],"research_program":[6746],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Impact of removing restrictive haemoglobin A1C eligibility criteria for insulin pump therapy funding for children with type 1 diabetes in Ontario, Canada<\/title>\n<meta name=\"description\" content=\"Aims \u2014 In Ontario, publicly funded insulin pump therapy has been available to children with Type 1 diabetes since 2006. Before 31 March 2022, eligibility\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/impact-of-removing-restrictive-haemoglobin-a1c-eligibility-criteria-for-insulin-pump-therapy-funding-for-children-with-type-1-diabetes-in-ontario-canada\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ICES | Impact of removing restrictive haemoglobin A1C eligibility criteria for insulin pump therapy funding for children with type 1 diabetes in Ontario, Canada\" \/>\n<meta property=\"og:description\" content=\"Aims \u2014 In Ontario, publicly funded insulin pump therapy has been available to children with Type 1 diabetes since 2006. 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