Children and young people across England and Wales are facing stark and widening inequalities in their type 1 diabetes care, according to the most recent National Paediatric Diabetes Audit (NPDA).
JDRF’s Chief Executive in the UK, Karen Addington, spoke out on the “dire picture of inequality” as JDRF and Diabetes UK underlined their joint determination to tackle barriers to type 1 diabetes technologies and treatments.
Poorer diabetes outcomes and worsening access to diabetes technology are just two of the disadvantages confronting children and young people from ethnic minority backgrounds and deprived areas, according to the NPDA report.
These inequalities could lead to life-long consequences, as higher average blood glucose levels (HbA1c levels) increase the risk of serious complications.
The report also shows that 44 per cent of children and young people with type 1 diabetes require additional psychological support beyond their usual care team.
This figure rose from 39 per cent in 2018/19 and 28 per cent in 2017/18, suggesting a trend that began long before the COVID-19 pandemic.
Type 1 diabetes technology inequalities in the NPDA
Diabetes technologies, such as insulin pumps and continuous glucose monitors (CGM), can help people with diabetes to manage their condition, and are being used by more children and young people than ever before.
However, technology use is lowest in children and young people from deprived areas and from ethnic minority communities.
The gap between children using an insulin pump in the most and least deprived areas has widened from 7.9% in 2014/15, to 12.6% in 2019/20.
What lies behind type 1 diabetes technology inequality?
There is limited research exploring why these inequalities exist in the UK. But JDRF’s Pathway to Choice report, published in 2020, highlighted people’s socio-economic status and finances as barriers that impact engagement with type 1 diabetes technologies. The report found that 25% of people from lower social level classifications (based on people’s jobs) have no awareness of flash glucose monitoring technology compared to 12% from higher social level classifications.
JDRF will also be working in partnership with Diabetes UK to develop research to reveal the barriers to equal access to diabetes technology. In the longer term this work will help identify targeted interventions to address this six-year trend of widening inequalities.
Karen Addington, UK Chief Executive of JDRF, said: “The latest NPDA findings paint a dire picture of inequality among children and young people with type 1 diabetes. Wearable medical technologies for managing type 1 diabetes can improve lives and clinical outcomes, yet children and young people from ethnic minority communities and socially deprived areas are particularly missing out.
“Everybody who wants and needs access to type 1 diabetes technology should receive it, which is why we’re calling for more to be done to reach people with type 1 from these groups. We’re working in partnership with Diabetes UK to understand the barriers, many of which were identified in our 2020 Pathway to Choice report, and call on the Government and local NHS bodies to work with us to overcome them.”
Chris Askew OBE, Chief Executive at Diabetes UK, said: “It is unacceptable that children and young people from ethnic minority communities and socially deprived areas have poorer diabetes-related outcomes and lower usage of diabetes technology. We need to understand precisely why these children and young people face such stark and widening inequalities to help address and solve the problem for future generations.”
He added: “But what we can do now is ensure that diabetes technology is made available to all children and young people who meet the eligibility criteria. This funding would save children with diabetes and their families from distress that nobody should have to face, and could help reduce hospital admissions from preventable complications. It is vital that the Government gives all people with diabetes the tools they need, today.”
Professor May Ng, Chair of the Diabetes Research Steering Group focused on Children & Young People who is leading the efforts to drive forward research in this area, said: “While this year’s NPDA reports that use of continuous glucose monitoring (CGM) and insulin pump technology is associated with better HbA1c outcomes, even when other factors are adjusted – it is very concerning that inequalities in health outcomes have grown, and the use of technologies in children with diabetes living in the most deprived areas and of ethnic minority backgrounds were faring worse. This disparity has widened over the last six years.”
She added: “For example, the gap between insulin pump and CGM usage amongst children from ethnic minority backgrounds and those living in the most and least deprived areas has widened with time from 2014 to 2020. We should be looking at why this is happening and how we should be reducing variations in care. It is time for everyone to act now.”
Read JDRF’s Pathway to Choice report – a programme building awareness of and access to type 1 technology choices.