Mind the gap: ongoing inequalities in glycaemic levels in young people living with type 1 diabetes across england and wales

Victoria Homer; Cillian Brophy; Robert French; Amani Krayem; Saira Pon-Perez; Justin Warner; Renuka Dias

doi:10.1530/endoabs.111.OC9.5

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Endocrine Abstracts (2025) 111 OC9.5 | DOI: 10.1530/endoabs.111.OC9.5

BSPED2025 Oral Communications Diabetes Oral Communications 2 (7 abstracts)

Mind the gap: ongoing inequalities in glycaemic levels in young people living with type 1 diabetes across england and wales

Victoria Homer ¹ , Cillian Brophy ² , Robert French ³ , Amani Krayem ² , Saira Pon-Perez ² , Justin Warner ⁴ & Renuka Dias ^1,5

Author affiliations

¹University of Birmingham, Birmingham, United Kingdom; ²National Paediatric Diabetes Audit, London, United Kingdom; ³Cardiff University, Cardiff, United Kingdom; ⁴University Hospital Wales, Cardiff, United Kingdom; ⁵Birmingham Children’s Hospital, Birmingham, United Kingdom

Background: Utilising data from the National Paediatric Diabetes Audit (NPDA) for England and Wales, inequalities in glycaemic levels in children and young people (CYP) living with Type 1 Diabetes (T1D) across different ethnic and socio-economic groups were first highlighted in 2016. Almost ten years on, we wanted to know if this difference persists.

Methods: Analysis of 27,919 CYP with T1D from the 2022-2023 NPDA. Multivariable linear regression was used to assess any association between HbA1c and Socio-economic status (SES) or ethnicity, adjusting for age, gender, diabetes duration and pump use.

Findings: CYP from ethnic minority groups continue to have significantly higher mean HbA1c levels compared to white CYP with the largest difference in black children (6.8 mmol/mol, [0.6%], 95% CI 5.7, 7.9 mmol/mol). Lower SES remains significantly associated with higher HbA1c levels with the largest difference between the least deprived and most deprived (6.9 mmol/mol; [0.6%], 95% CI: 6.4, 7.6) (see Table 1) Additionally, CYP from ethnic minority groups (Black 34.2% vs White 49.56%, P < .0001) and those living in more deprived neighbourhoods (Most Deprived 41% vs Least deprived 54% vs P = 0.0001) were less likely to use insulin pumps.

Table 1
	White	Black	Least Deprived	Most Deprived
HbA1c mmol/mol (SD)	63.1 mmol/mol (15.8)	69.9 mmol/mol (18.0)	60 mmol/mol (13.7)	66.9 mmol/mol (17.7)

Conclusions: Ethnicity and SES remained significant predictors of HbA1c level. Black CYP continue to have the highest glycaemic levels, and lower SES remains associated with poorer HbA1c outcomes. Substantial inequalities persist in the use of insulin pump therapy highlighting the ongoing need for targeted interventions to improve equity in diabetes care and outcomes.