Endocrine Abstracts

Aims: To assess the impact of socio-economic deprivation on access to diabetes technology, specifically insulin pumps, and its outcome in children with type 1 diabetes.

Methods: We designed a retrospective, observational single-centre study of patients attending the paediatric unit at Basildon & Thurrock University Hospital (BTUH). The study included all patients actively receiving diabetic care as of April 2023, including those with access to insulin pumps between January 2012 and April 2023, with their HBA1c values assessed before and after insulin pump treatment. Deprivation quintiles were calculated using the English Indices of Deprivation 2019. Statistical significance was calculated via unpaired t-tests, one-way ANOVAs and chi-squared tests.

Results: Included in the study were 243 children with a mean age of 13 years, of which 117 were males (48%). Of this caseload, 48 children had active access to insulin pumps with a mean deprivation quintile of 3.15 (S.D. 1.44). Quintile 1 identified the most deprived populations and quintile 5, the least deprived. The insulin pumps were most accessible for children in the least deprived quintile compared to those in the most deprived quintile (31% vs. 10%; P<0.01). Within the caseload, following initiation of treatment, children in the most deprived quintile had the highest mean HBA1c values compared to the lowest values in the least deprived quintile [67.83 (S.D. 24.72) vs. 51.64 (S.D. 9.45); P=0.027]. HBA1c outcomes were available for 35 children using pumps, with no statistically significant link to deprivation (P=0.348). Children of white ethnicity had the highest use of insulin pumps compared to any other ethnicity (88% vs. 12%, P<0.0001).

Conclusions: Inequalities in access to diabetic technology still exist, with children in the least deprived quintile and those of white ethnicity experiencing greater access to technology. Children from all deprivation quintiles experienced positive glycaemic control with technology use, suggesting improving access to technology may reduce glycaemic disparities in deprived populations. Owing to strict criteria from NICE and integrated care boards for approval of diabetic technology, the most deprived populations are disadvantaged by their lack of exposure, awareness and engagement. Further research is yet required to address these health inequalities.