1519-P: Predictors for Timing of Insulin Pump Initiation among Individuals with Type 1 Diabetes in Ontario, Canada
Bibliographic record
Abstract
Introduction and Objective: Early initiation of insulin pump therapy may be important for optimizing glycemic levels during the early time period following diagnosis of T1D, which is critical for improving long-term outcomes. In Ontario, insulin pump therapy for T1D is publicly funded through the Assistive Devices Program (ADP). This study assessed patient- and physician-level characteristics associated with timing of insulin pump initiation among new applicants to ADP in Ontario. Methods: A retrospective population-based cohort study was conducted using administrative healthcare databases in Ontario, Canada. New applicants to ADP between 1 Dec 2006 (age ≤ 18) or 1 Sep 2008 (all ages) and 31 Mar, 2021 were included. An adjusted log-binomial regression model using generalized estimating equations was used to assess associations between patient- and physician-level characteristics and early (within 2 years of T1D diagnosis) versus late (greater than 2 years) insulin pump initiation. Results: Among 4899 individuals with T1D using insulin pumps, 62.6% were early pump initiators. Greater social disadvantage was associated with lower relative risk of early insulin pump initiation (adjusted relative risk [RR] 0.80 [95% confidence interval {CI} 0.74-0.87] for most v. least disadvantaged quintile). General internists (0.85 [0.74-0.97]) and family physicians (0.38 [0.27-0.54]) were less likely than pediatricians to prescribe insulin pump therapy early. Older patient age at diagnosis, physician training pre-initiation of the ADP funding program, and no physician affiliation with an ADP clinic were also associated with late insulin pump initiation Conclusion: Social disadvantage and physician characteristics are associated with late insulin pump initiation, which may have negative long-term effects on glycemic levels. Barriers to early insulin pump initiation should be prioritized to promote equitable insulin pump uptake and glycemic outcomes. Disclosure X. Zhu: None. L. Lipscombe: None. R. Shulman: Advisory Panel; Dexcom, Inc. K. Everett: None. A. Weisman: None. L. Lovblom: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".