Endocrine Abstracts

Introduction: Children and young people with T1DM living in the least deprived areas have better diabetes control vs those in most deprived areas with UK NPDA data suggesting that deprivation and ethnicity are associated with less use of technology.¹

Aims: 1. Review distribution of technology between different socio-economic and ethnic groups 2. To compare mean recent HbA1c results between groups using different combinations of technology

Method: Using databases (EPR and Twinkle) we obtained data on all T1DM patients under Wythenshawe Hospital. An IMD deprivation score was generated using postcode (English indices of deprivation 2019) and converted into deciles. We used regression modelling to analyse the relationship between technology, deprivation, demographics and HbA1c.

Results: 142 patients were reviewed with 47.9% using insulin pumps, 46.5% using multiple daily injections (MDI) with continuous glucose monitoring (CGM) and 5.6% using MDI and finger-prick testing. For HbA1c comparison we used 52 patients on pumps (16 excluded) and 65 patients injections (9 excluded). Our population had similar proportions of ethnic groups, compared to nationally, however it is more skewed to the extremes of social deprivation. There was similar use of diabetes technology across all ethnic and socio-economic groups. There was less use of insulin pumps in the Black ethnicity group (n=6). HbA1c results were significantly higher in the most deprived compared with the least deprived areas. For each increasing decile of IMD, HBA1c is 0.75 mmol/mol lower (95%CI -1.48 - -0.02) P=0.045. There was no significant difference between closed loop and non-closed loop pump systems b=2.16 (95%CI -3.13 – 7.46) P=0.415. For patients on MDI, there was no significant difference between finger-prick testing and CGM. Insulin pumps were associated with an HbA1c 9.57 mmol/mol lower (95%CI 4.41- 14.73) (P=<0.001).

Conclusion: Despite even distribution of technology between socioeconomic groups increasing levels of deprivation were associated with worsening glycaemic control. Further work should include looking at more detailed data to assess use of technology (e.g time in range, percentage sensor use) and to collect qualitative data on patient’s experience.

References: 1. NPDA Annual Report 2020-21: Care Processes and Outcomes. London: RCPCH, 2022.