Evidence map›Paper›PMID 27547416›Full record

ArticleBMJ open diabetes research & care2016

Low socioeconomic status is associated with adverse events in children and teens on insulin pumps under a universal access program: a population-based cohort study.

Rayzel Shulman, Therese A Stukel, Fiona A Miller, Alice Newman, Denis Daneman, Jonathan D Wasserman, Astrid Guttmann

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open diabetes research & care, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 1 pooled it
4.7field-weighted citation impact, top 5% of its field
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

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

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

19 citing papers in PubMed, 1 synthesis or guideline pooled it, 39 citations in OpenAlex.

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4 · The record

Corrections and comments

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

7 authors at 4 institutions in 1 country.

Rayzel ShulmanDepartment of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Sickkids Research Institute; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Therese A StukelInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Fiona A MillerInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Ontario, Canada.
Alice NewmanInstitute for Clinical Evaluative Sciences , Toronto, Ontario , Canada.
Denis DanemanDepartment of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Sickkids Research Institute.
Jonathan D WassermanDepartment of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Sickkids Research Institute.
Astrid GuttmannDepartment of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Sickkids Research Institute; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Hospital for Sick Children · CAInstitute for Clinical Evaluative Sciences · CAUniversity of Toronto · CASickKids Foundation · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo describe adverse events in pediatric insulin pump users since universal funding in Ontario and to explore the role of socioeconomic status and 24-hour support. RESEARCH DESIGN AND

methodsPopulation-based cohort study of youth (<19 years) with type 1 diabetes (n=3193) under a universal access program in Ontario, Canada, from 2006 to 2013. We linked 2012 survey data from 33 pediatric diabetes centers to health administrative databases. The relationship between patient and center-level characteristics and time to first diabetic ketoacidosis (DKA) admission or death was tested using a Cox proportional hazards model and the rate of diabetes-related emergency department visits and hospitalizations with a Poisson model, both using generalized estimating equations.

resultsThe rate of DKA was 5.28/100 person-years and mortality 0.033/100 person-years. Compared with the least deprived quintile, the risk of DKA or death for those in the most deprived quintile was significantly higher (HR 1.58, 95% CI 1.05 to 2.38) as was the rate of diabetes-related acute care use (RR 1.60, 95% CI 1.27 to 2.00). 24-hour support was not associated with these outcomes. Higher glycated hemoglobin, prior DKA, older age, and higher nursing patient load were associated with a higher risk of DKA or death.

conclusionsThe safety profile of pump therapy in the context of universal funding is similar to other jurisdictions and unrelated to 24-hour support. Several factors including higher deprivation were associated with an increased risk of adverse events and could be used to inform the design of interventions aimed at preventing poor outcomes in high-risk individuals.

Identifiers

PMID27547416
PMCPMC4932320
OpenAlexW2464027477

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
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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 OpenQuestion graph.