Endocrine Abstracts

The National Paediatric Diabetes Audit (NPDA) has identified inequalities in diabetes care associated with ethnicity, including use of diabetes-related technology. Children with type 1 diabetes mellitus (T1DM) from a Black, Asian, and Minority Ethnic (BAME) background are less likely to use routine continuous glucose monitoring (CGM), insulin pumps and hybrid-closed loop (HCL) systems (NPDA 2019-2023). HCL use is associated with enhanced glycaemic control and quality of life for patients and their carers (Ng et al, 2024). Using the Diamond electronic patient record, we identified 104 patients with T1DM under the care of Nottingham Children’s Hospital who identify as a non-white ethnicity. Records were reviewed (November 2024 – March 2025) to collect data on CGM, pump, and HCL use. Reasons for non-use and data on clinical outcomes such as HbA1c and time in range over a 3-month period was also collected. Eighty-six patients (82%) were on pumps/HCL compared to 66% overall clinic uptake, 55% national uptake (NPDA 2023-24) and 58% regional uptake (NPDA Unit Level Report East Midlands 2023-24). Of those not on a pump, all were offered HCL therapy: 2 were awaiting pump starts, 5 recently attended a showcase, 4 had booked a showcase, and 2 were previously on a pump and decided to revert to injections. Eleven patients were not on a pump and had not attended/planned to attend a showcase. Reasons given included: concerns about sport, social stigma, disliking the sensation of being attached to a pump and, anxiety. These patients had a similar HbA1C (54.4 mmol/mol) and TIR (61.8%) to those on HCL (54.5 mmol/mol and 61.9% respectively). Older male teenagers were overrepresented in those declining pumps/HCL. Allowing for small numbers in individual groups, there was no ethnic group markedly less likely to decline pump/HCL use. HCL is now considered standard care and, reassuringly, ethnicity does not appear to be associated with reduced diabetes technology use in the NUH cohort. However, male teenagers are at risk of being disadvantaged and require specific consideration. Nevertheless, barriers to use remain, and are complex and multifactorial. To reduce disparities, care teams must continue to ensure that care is culturally, socially, and ethnically relevant.