Endocrine Abstracts

Introduction: Delivering an equitable service is one component defining a quality service. Various factors impact on diabetes control including health beliefs and socioeconomic pressures. To determine the role played by ethnicity and/or deprivation we audited access to insulin treatment regimens and overall diabetes control in our clinic population of children and young people with type 1 diabetes mellitus (CYPT1DM).

Methods: Three hundred and twenty-five (170M; age 2–19 years) CYPT1DM were studied. HbA1c measured on four occasions during the year and averaged was used to measure diabetes control. Ethnicity was derived from NHS Standard Demographic Dataset and Deprivation Score (2007) from home postcode. Interactions were sought between ethnicity and/or deprivation and insulin regimen utilised and HbA1c.

Results: Median clinic HbA1c was 7.8% with 2.7% using twice daily (BD), 48.4% multiple (MDI) and 48.9% pump regimens. Average deprivation score was 21.06 which is similar to London. Ethnic proportions were similar to the UK population with a slightly higher proportion of families of African origin. Deprivation score associated with HbA1c (r=0.14; P=0.02) and were highest in the African and Indian (non-Hindu) groups (P<0.001) with a similar trend for HbA1c (P<0.001). 52.8% of the white and Indian (Hindu) groups received pump therapy compared to 26.9% of the African and Indian (non-Hindu) groups (χ² 50.3; P<0.001). Although those on pumps had a lower deprivation score (16.39) compared to those on MDI (24.63) or BD (40.51) all the BD were white. In regression modelling 10.0% of the variance in the clinic HbA1c was explained by ethnicity and insulin therapy (P<0.001).

Conclusion: These data suggest that ethnicity plays an important role in determining HbA1c but how it influences insulin regimen is unclear. The effect does not appear to relate to deprivation per se suggesting health related beliefs in these populations or amongst health care professionals may be operative.