New data from the National Paediatric Diabetes Audit (NPDA) has revealed a six-year trend of widening inequalities in the care of children and young people with type 1 diabetes in England and Wales. These include poorer diabetes outcomes and worsening access to diabetes technology in children and young people from ethnic minority backgrounds and socially deprived areas.
A total of 27,653 children and young people in the UK have type 1 diabetes according to the NPDA – which means the UK has the highest prevalence of type 1 diabetes in children and young people in Europe.
Blood Sugar Levels
The report has found that children and young people with type 1 diabetes from ethnic minority backgrounds are more likely to have higher average blood sugar levels (HbA1c) compared to White children. Black children and young people were found to have the highest average HbA1c levels, followed by children with a Mixed ethnic background and Asian children, and then White children, respectively. The report also shows that children in the most deprived areas are more likely to have higher average HbA1c levels than those in less deprived areas.
A high HbA1c level means too much sugar in the blood over time. This increases the risk of developing serious complications.
Diabetes technologies, like Continuous Glucose Monitors (CGMs) and insulin pumps, help people with diabetes to manage their condition and have been shown to improve their health and wellbeing, including lowering their HbA1c. And while the NPDA reports an upward trend in the use of diabetes technologies overall, technology use is lowest in children and young people from socially deprived areas and from ethnic minority backgrounds.
For example, the report shows that in 2019/20 the percentage of Black children with type 1 diabetes using CGMs is 11.7% and for insulin pumps 26.7%, whereas for White children these percentages are close to double at 20.2% and 39.8% respectively. The report also showed that 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.
Our ambition for change
There isn't yet enough research exploring exactly why these inequalities exist in the UK. But there is clear action that can be taken now.
We believe that the government should provide urgent funding to end the postcode lottery which partially explains why access to diabetes technology varies so much depending on where you live, your ethnicity and whether your area is deprived or not.
Government and funders should also commit to funding more research to understand all the reasons why these inequalities exist. This way, we'll better understand what's going on and what can be done to address inequalities.
To help make this happen, we’re working with leading diabetes researchers through our Diabetes Research Steering Groups and in partnership with JDRF, to develop research to reveal barriers to equal access to diabetes technology. In the longer term, this work will help identify ways of reversing this 6-year trend of widening inequalities.
New research into these issues will take time and commitment from government and funders to happen but ending the postcode lottery is something that can be addressed today. That is why we're urging the UK Government to take immediate action to ensure that every child and young person can access diabetes technology regardless of where they live.
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.
“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.”
Chris sets out our ambition for change in full in his statement on these stark inequalities in access to diabetes technology.