Endocrine Abstracts

Background: The National Paediatric Diabetes Audit (NPDA) continues to identify inequalities in diabetes care. Children and young people with type 1 diabetes mellitus (T1D) from deprived areas are likely to have a higher HbA1C and a lower rate of access to diabetes technologies. We aimed to assess the access to technology of our clinic population from deprived areas compared to the overall clinic and national NPDA data.

Method: Index of Multiple Deprivation (IMD) deciles were derived, based on recorded postcode, for each patient with T1D under the care of Nottingham Children’s Hospital. As of September 2024, the use of technology (continuous glucose monitoring, pump/hybrid-closed loop), average HbA1C and demographic data were ascertained for patients from IMD decile group 1 (IMD1).

Results: Within IMD1, there were 62 patients, of which 33 were male (53.2%). The average HbA1c was 56.8 mmol/mol, similar to 56.4 mmol/mol in the clinic as a whole. Although most patients in this cohort identified as white, patients identifying as other ethnic backgrounds were over-represented. All 62 patients had been offered pump/HCL therapy. Of the 20 patients not on a pump/HCL, 8 were awaiting to start and 4 had recently attended a pump showcase. The average HbA1c was 56.5 mmol/mol for those on a pump and 57.7 mmol/mol for those not. 5 of 8 patients who had declined pump/HCL therapy were white, male and older adolescents. 2 had been admitted to the ward previously for stabilisation.

Conclusions: Nationally, patients in IMD1 are at risk of reduced access to diabetes technology, which can result in compounding social, economic, and health disparities. Local access rates (68%) are comparable to NPDA 2023-24 rates for the two most deprived deciles (66.8%), and their outcomes are similar to our overall clinic outcomes. In contrast to the national NPDA data, the average HbA1c was similar for those on a pump and those not on a pump within IMD1. Older male patients are at risk of continuing to be disadvantaged and require particular targeted interventions to optimise uptake of technology.