Impact of Socioeconomic Deprivation on Access to Diabetes Technology in Children With Type 1 Diabetes Mellitus

TL;DR

Children from less deprived backgrounds and White ethnicity have better access to diabetes technology like insulin pumps, which may help reduce health disparities.

Contribution

The study reveals socioeconomic and ethnic disparities in access to diabetes technology and its impact on glycaemic control in children.

Findings

Children in the least deprived quintile had significantly higher access to insulin pumps compared to the most deprived quintile.

White ethnicity was strongly associated with higher insulin pump usage compared to other ethnicities.

Glycaemic control improved with pump use across all deprivation levels, but no significant link to deprivation was found in HbA1c outcomes.

Abstract

Aims

The aim of this study was to assess the impact of socioeconomic deprivation on access to diabetes technology, specifically insulin pumps, and its outcome in children with type 1 diabetes.

Methods

This was a retrospective, observational, single-centre study of patients attending the paediatric unit at Basildon University Hospital, Basildon, United Kingdom. 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 initiating insulin pump treatment. Deprivation quintiles were calculated. Statistical significance was calculated via chi-square tests, one-way ANOVA, and logistic regression approximation analysis.

Results

Included in the study were 243 children and young people (CYP) with a mean age of 13 years, 117 of whom were male (48%). Of this caseload, 48 had active access to insulin pumps with a mean deprivation quintile of 3.15 (SD 1.44). Quintile 1 identified the most deprived populations, and quintile 5, the least deprived. The insulin pumps were most accessible for CYP 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, CYP in the most deprived quintile had the highest mean HbA1c values compared to the lowest values in the least deprived quintile (67.83 (SD 24.72) vs. 51.64 (SD 9.45); p=0.027). HbA1c outcomes were available for 35 CYP using pumps, with no statistically significant link to deprivation (p=0.348). CYP 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 CYP in the least deprived quintile and those of White ethnicity experiencing greater access to technology. CYP from all deprivation quintiles experienced positive glycaemic control with technology use, suggesting improving access to technology may reduce glycaemic disparities in deprived populations. The most deprived populations might be disadvantaged due to their lack of exposure and awareness about newer technologies and advancements in diabetes care, as well as sub-optimal engagement with diabetes services, which is often seen in these cases. Further research is yet required to address these health inequalities.

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