October 4, 2022
2 min read
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Adults with type 1 diabetes in the UK are less likely to use diabetes technology if they face greater socioeconomic deprivation, despite the benefits of using technology, according to findings published in the January issue. diabetes medicine.
“Our study provides real-world evidence for differences in diabetes technology use across racial and socioeconomic deprivation, with the lowest rates of use among the poorest quintiles,” Parizad Avari, MBBS, BSc, MRCPwrite clinical researchers and colleagues from the Department of Metabolism, Digestion and Reproduction at Imperial College London. “Importantly, technology use improved HbA1c outcomes regardless of social deprivation and ethnicity.”
Researchers conducted a retrospective observational study of 1,631 adults with type 1 diabetes using diabetes services at three hospitals under the Imperial College London National Hospital Services Trust (mean age 44; 47% women) . Data on demographics, diabetes diagnosis, technology use, and HbA1c before technology initiation and 1 year after device initiation were collected from electronic medical records. The 2019 UK Deprivation Index measures socioeconomic deprivation. The study cohort was divided into quintiles according to the level of deprivation.
Racial disparities exist among socioeconomic quintiles. In the poorest quintile, 62 percent were white and 1.1 percent were black, while in the poorest quintile, 41 percent of participants were white and 15 percent were black.phosphorus < .001 for both).
In the study cohort, 55% used technology, 24% used continuous subcutaneous insulin infusion, 19% used real-time continuous glucose monitoring, and 34% used intermittent scanning CGM. A higher proportion of participants using diabetes technology were in the poorest socioeconomically poorest quintile compared to the poorest quintile (67% vs. 45%; phosphorus < .001). Technology use increases linearly across all quintiles, with 53% in the second poorest, 56% in the middle quintile, and 56% in the second poorest was 62%. Results were similar in adults using a combination of continuous subcutaneous insulin infusion and CGM.
HbA1c data were available for 56 adults using continuous subcutaneous insulin infusion, 89 adults using real-time CGM, and 255 adults using intermittent scanning CGM. All three technique types showed overall benefit, with continuous subcutaneous insulin infusion and real-time CGM users having a 2.8% reduction in HbA1c from pre-initiation to 1 year post-initiation, while intermittent scan CGM showed a 2.7% reduction in HbA1c. There was no difference in HbA1c reduction in one-fifth of socioeconomic deprivation.
“Glucose was positively affected in all groups,” the researchers wrote. “This suggests that reducing inequalities in technology access may address the differences observed in blood glucose.”
In the study cohort, 33% participated in structured diabetes education. As deprivation worsens, adults are less likely to participate in diabetes education, with 23% of those in the poorest quintile having completed diabetes education, compared with 23% in the poorest quintile The ratio is 43%.phosphorus < .001).
“Health disparities must be recognized and addressed,” the researchers wrote. “Qualitative research that assesses structural, policy, healthcare professional and individual causes of disparities in technology use and deprivation will provide greater insight into the causes of social inequality in health and Uncover potential areas of intervention to prevent these inequalities.”