Publication, Part of National Diabetes Audit, Type 1 Diabetes
National Diabetes Audit 2021-22, Type 1 Diabetes - Detailed Analysis Report
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3 June 2024 00:00 AM
Section 2 - Inequalities
HbA1c levels and glucose technology
There is a relationship between the type of glucose technology used and the resulting HbA1c levels in adults with type 1 diabetes. The charts in figures 7 and 8 show that larger proportions of the groups of people with HbA1c below 70 mmol/mol were using wearable glucose monitors, and/or using insulin pumps than in the group of people with HbA1c of 70 mmol/mol or higher.
Access to diabetes technology - demographic factors
Use of insulin pumps and wearable glucose monitors is not distributed across age, ethnicity or deprivation groups in the same way as the overall population of adults with type 1 diabetes. Figure 9 shows that higher percentages of people in younger age groups, less deprived groups and white ethnicity groups are prescribed wearable glucose monitors compared to people in older, more deprived and asian, black or mixed/other ethnicity groups. Figure 10 shows a similar pattern with respect to access to insulin pump technology.
Access to technology - geography
The maps in this section show that there is a degree of variation in the use of insulin pumps and wearable glucose monitors across the ICBs of England, and Wales. Some ICBs have relatively high percentages of users of both these technologies (for example NHS Surrey Heartlands has 14.3% insulin pump use and 55.5% wearable glucose monitor use), and some have a high level of 1 of the technologies but a low level of the other (for example NHS Cambridgeshire and Peterborough has 18.4% on insulin pumps but only 33.7% using wearable glucose monitors). Other ICBs however have low percentages for both technologies (for example NHS Mid and South Essex has 7.9% insulin pump and 43.8% wearable glucose monitor use).
Figure 11 illustrates that use of insulin pumps varies across England and Wales. The percentage of adults with type 1 diabetes using insulin pumps in NHS Cambridgeshire and Peterborough ICB was roughly 3 times the percentage in NHS Gloucestershire ICB.
Figure 12 illustrates that use of wearable glucose monitors varies across England. The percentage of adults with type 1 diabetes using wearable glucose monitors in NHS Cambridgeshire and Peterborough ICB was just over half the percentage in neighbouring NHS Northamptonshire ICB.
Please note that data on flash glucose monitoring is not available for Wales, so there is no analysis of wearable glucose monitors for Wales.
Inequalities in access to diabetes technology at ICB level
The following 4 charts illustrate that access to diabetes technology appears to be biased towards less deprived groups across the ICBs.
Figures 13 and 14 show the percentages of adults with type 1 diabetes in the most and least deprived quintiles respectively. They also show the percentages of insulin pump users in the most and least deprived quintiles. As expected, some ICBs have a much larger proportion of their population who are deprived than others. However, almost across the board, the percentage of people accessing pump technology in the most deprived quintiles is lower than the percentage of all type 1 people in the quintile. So for example, in NHS Buckinghamshire, Oxfordshire and Berkshire West ICB (QU9), 2.4% of the type 1 population are in the most deprived quintile, but only 0.7% of pump users are in that quintile. At the other end of the deprivation spectrum, 49.0% of people are in the most deprived quintile in NHS Black Country ICB (QUA), yet only 42.4% of pump users are in that quintile. For the least deprived quintile, the results are reversed - almost across the board, the percentage of people with access to insulin pumps in the quintile is higher than the percentage of type 1 people in the quintile.
For Wales, the differences between the percentage of all adults with type 1 diabetes in the least/most deprived groups and the percentage of pump users in those groups are smaller than for most of the ICBs. This may indicate that access to insulin pump technology is more equitable across deprivation groups in Wales.
Figures 15 and 16 show similar results for access to wearable glucose monitors, although the gap between the percentages is not so great as for insulin pump.
A full list of ICB codes and names can be found in the Additional Information section of this report.
Additionally, information on ICB codes can be found on the Organisation Data Services website
Last edited: 3 June 2024 10:29 am