Closing the Gap: Early Access to Diabetes Tech for Every Child

For children newly diagnosed with type 1 diabetes, the first months of care can shape health outcomes for years to come. Yet many children — particularly those from publicly insured or under-resourced families — still encounter barriers to accessing automated insulin delivery (AID) technology during this critical window, often based on the mistaken belief that the technology is too complex to manage early on. 

A new pilot study led by the UCSF Department of Pediatrics directly challenges this assumption. Published in the Journal of Diabetes Research, the study shows that providing AID devices immediately after diagnosis is not only feasible and safe, but also highly effective for children from all backgrounds — delivering better glucose control and offering a powerful opportunity to reduce long-standing disparities in pediatric diabetes care. 

The Oakland Advantage 

Most clinical trials for diabetes technology primarily enroll participants who are privately insured and identify as non-Hispanic White. But Kevin Yen, MD, the study's lead author and UCSF pediatric endocrinologist, intentionally took a different path and enrolled a cohort directly from the real-world population of the diabetes clinic at UCSF Benioff Children’s Hospital Oakland.  

The study focused on youth aged 6-21 within just three months of their type 1 diabetes diagnosis. 89 percent of participants were from underrepresented racial or ethnic groups, 70 percent were publicly insured, and nearly half reported experiencing food insecurity. 

"For some health care teams, there has been a concern that introducing AID devices is overwhelming for families already navigating a new diagnosis," says Jenise Wong, MD, PhD, the study’s senior author. "Our study set out to see if starting AID early is feasible for all families, and the results show that care teams should take an unbiased approach to discussing technology with everyone." 

Challenging Assumptions 

The pilot randomized participants into two groups: those receiving the AID system immediately, and those receiving "usual care" (injections or insulin pumps through usual clinic workflows). 

The results debunked the fear that early technology adoption is unsafe for this demographic. There were no major adverse events — such as severe hypoglycemia or diabetic ketoacidosis — in the AID group. Furthermore, 85 percent of participants continued using the system six months after the study concluded, demonstrating high acceptability. 

The technology also made a tangible difference in health outcomes. At the 3-month mark, half of the AID group achieved the benchmark for healthy blood glucose levels (greater than 70% "Time in Range"). Zero participants in the control group reached this same benchmark. 

"Nearly all studies show that technology helps those starting furthest from their goals the most," says Wong. "Starting AID early could help reduce the disparities between publicly and privately insured children." 

Redefining Support 

Tailored support was essential to the study’s success. Recognizing gaps in traditional support systems, the team made themselves available through text and often helped troubleshoot devices outside of business hours. 

"Our diabetes educators — Jeannie Hickey, Lois Carelli, and Crystal Loucel — were critical to this work," says Wong. "This frequent, reliable communication helped establish a foundation of trust that we can maintain for successful long-term diabetes management." 

However, the technology does bring its own set of challenges for young patients. Children in the study often felt frustrated by device alarms and the social stigma of beeping in the classroom. 

To address these hurdles, UCSF is now piloting virtual peer groups and shared medical appointments. These programs help normalize the technology and allow families to connect, share troubleshooting tips, and find community with others navigating the same journey. 

A New Standard of Care 

This study provides evidence needed to shift national clinical practice. UCSF is already leading the way: diabetes education sessions are available in multiple languages, and most newly diagnosed children now leave the hospital using continuous glucose monitoring (CGM) technology.  

Crucially, UCSF has eliminated arbitrary requirements for device access that were once common in other clinics, including waiting a year after diagnosis or requiring families to keep manual logs to prove their preparedness. 

By showing that all families can safely benefit from these life-changing tools with the right support, UCSF is ensuring that the best possible care isn’t only a privilege for some, but a standard for all.  

Learn more about the world-class team and patient-centered programs at the UCSF Division of Pediatric Endocrinology. 

Authors: Other authors from the UCSF Department of Pediatrics include Sonali Belapurkar, MD, Loren Yglecias, and Maya Lodish, MD. Please see the paper for the full list of authors. 

Funding: National Institutes of Health (T32DK007161) and the Cohen–Klebanoff Fund for Pediatric Diabetes.