Mind the gap: Ongoing inequalities in glycaemic levels in young people living with Type 1 diabetes across England and Wales

AIMS: Inequalities in glycaemic levels in children and young people (CYP) living with Type 1 diabetes (T1D) across different ethnic and socio-economic groups in England and Wales were first highlighted in 2016. Almost 10 years on, we wanted to know if the gap has been closed. METHODS: Analysis of 27,919 CYP with T1D from the 2022-2023 National Paediatric Diabetes Audit (NPDA). Multivariable linear regression was used to assess any association between socio-economic status (SES), ethnicity or insulin pump use and HbA1c, adjusting for age, gender and diabetes duration. RESULTS: CYP from ethnic minority groups continue to have significantly higher mean HbA1c levels compared to White CYP with the largest difference in Black children (6.8 mmol/mol, [0.6%], 95% CI 5.7, 7.9 mmol/mol). Lower SES remains associated with higher HbA1c levels with the largest difference between the least deprived and most deprived (7.0 mmol/mol; [0.6%], 95% CI: 6.4, 7.6). CYP from ethnic minority groups (Black 34.2% vs. White 49.56%, p < 0.0001) and those living in more deprived neighbourhoods (Least Deprived 54% vs. Most Deprived 41%, p = 0.0001) were less likely to use insulin pumps. CONCLUSIONS: Ethnicity and SES remained significantly associated with HbA1c levels even after accounting for the use of insulin pumps. Black CYP continue to have the highest glycaemic levels, and lower SES remains associated with poorer HbA1c outcomes. Substantial inequalities persist in the use of insulin pump therapy highlighting the ongoing need for targeted interventions to improve equity in diabetes care and outcomes.