Endocrine Abstracts

Introduction: Racism is a fundamental determinant of health, described by Prof Kevin Fenton (PHE) as a "wicked problem"- a complex problem highly resistant to solutions. The amplification of the voice of black lives matter” and disproportionate number of deaths from Covid-19 in Black and Asian people has re-focussed attention on racial health inequalities. Structural racism and unconscious bias is present throughout medicine. The National Paediatric Diabetes Audit (NPDA) continues to reveal widening socioeconomic and ethnic disparities concerning use of technologies associated with lower HbA1c, and improved health outcomes. Nationally, use of insulin pump therapy is almost twice as likely in White British children (39.8%) compared to Black children (26.7%) and yearly mean HbA1c remains higher in Black children independent of deprivation.

Methods: Using data from the diamond database and NPDA, we measured insulin pump usage, HbA1c, age, ethnicity, and socioeconomic quintile, in the 387 children with type one diabetes in Nottingham from April 2020 to March 2021. In line with the NPDA we excluded HbA1c results taken within 90 days of diagnosis.

Results: Nottingham has a higher proportion of children in the most deprived quintile (30.4%) compared to national average (23.9%)², and higher pump usage 52.4% (38% nationally). The national trend of pump distribution and HbA1c is reversed; the least deprived receive the fewest pumps (41%) and have the highest HbA1c (63 mmol/l), and the most deprived use most pumps (63%) with lower HbA1c (57 mmol/l). There is more equitable pump use across all ethnic groups compared to nationally (in brackets), White: 54% (40%), Asian: 56% (30%), Mixed 46%, (35%), and Black 41% (27%) but children of “other ethnic origin” are the least likely to receive pump therapy 0% (35%), however numbers are low (n = 14). Mean HbA1c was lower across all ethnic groups than nationally (), with White: 57.1 mmol/l (64.6), Asian: 56.2 mmol/l (65.8), Mixed 63.6 (67.1), and Black: 58.8 mmol/l (71.9).

Conclusion: Nottingham is significantly ahead of the national average for pump provision and HbA1c in Black and Asian children, but must continue to identify and mitigate against barriers to ethnic and socioeconomic equality in order to see excellent outcomes for all.