Adults facing more socioeconomic deprivation less likely to use diabetes technology
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Adults in the U.K. with type 1 diabetes are less likely to use diabetes technology if they face more socioeconomic deprivation despite the benefits of technology use, according to study findings published in Diabetic Medicine.
“Our study provides real-world evidence for differences in the use of diabetes technology across ethnicity and socioeconomic deprivation with the lowest use in the most deprived quintile,” Parizad Avari, MBBS, BSc, MRCP, clinical research fellow in the department of metabolism, digestion and reproduction at Imperial College London, and colleagues wrote. “Importantly, technology use improved HbA1c outcomes, irrespective of social deprivation and ethnicity.”
Researchers conducted a retrospective observational study of 1,631 adults with type 1 diabetes utilizing diabetes services across three hospitals under the umbrella of the Imperial College London National Hospital Service Trust (mean age, 44 years; 47% women). Demographics, data of diabetes diagnosis, technology use and HbA1c before starting technology and 1-year post-device initiation were collected from electronic medical records. The English Indices of Deprivation 2019 was used to measure socioeconomic deprivation. The study cohort was divided into quintiles based on deprivation level.
There were racial disparities between the socioeconomic quintiles. Of the least-deprived quintile, 62% were white and 1.1% were Black, whereas 41% of participants in the most-deprived quintile were white and 15% were Black (P < .001 for both).
Of the study cohort, 55% used technology, with 24% using continuous subcutaneous insulin infusion, 19% using real-time continuous glucose monitoring and 34% using intermittently scanning CGM. A higher proportion of participants in the least socioeconomically deprived group used diabetes technology compared with the most-deprived quintile (67% vs. 45%; P < .001). There was a linear increase in technology use across all quintiles, with the proportion of people using technology at 53% in the second-most deprived group, 56% in the middle quintile and 62% in the second-least deprived group. Findings were similar for adults using a combination of continuous subcutaneous insulin infusion and CGM.
HbA1c data were available for 56 adults using continuous subcutaneous insulin infusion, 89 using real-time CGM and 255 using intermittently scanned CGM. All three technology types showed overall benefit, with reductions in HbA1c of 2.8% for continuous subcutaneous insulin infusion and real-time CGM users from pre-initiation to 1-year post-initiation, and an HbA1c reduction of 2.7% with intermittently scanned CGM. There were no differences in HbA1c reduction among the socioeconomic deprivation quintiles.
“Glycemia was positively affected in all groups,” the researchers wrote. “This suggests that reducing inequalities in technology access may resolve the disparities observed in glycemia.”
Of the study cohort, 33% participated in structured diabetes education. As deprivation status worsened, adults were less likely to participate in diabetes education, with 23% in the most-deprived quintile completing diabetes education compared with 43% in the least-deprived quintile (P < .001).
“It is imperative that health disparities are recognized and addressed,” the researchers wrote. “Qualitative research evaluating structural, policy, health care professional and individual reasons for differences in technology use with deprivation would provide a deeper insight into the causes for social inequalities in health and uncover areas for potential interventions to prevent these.”
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