LIVERPOOL— Many young people, most often from ethnically diverse or socially deprived backgrounds, are missing out on the potential benefits of diabetes technology through poor uptake, despite guidelines supporting the wide availability of flash and continuous glucose monitoring devices on the NHS, according to data presented at this year's Diabetes UK Professional Conference.
However, a community outreach project – a 'tech café' aimed at encouraging uptake of diabetes technology in ethnically diverse and socially deprived young people in East London yielded a 33% increase 6 months after the intervention.
Study lead Dr Meera Ladwa, a registrar at Barts Health Young Adult Diabetes Service at Newham University Hospital in London, presented the results.
"There are lots of young people in these communities interested in diabetes technology who can control their diabetes successfully, where previously we may not have recognised this opportunity," she said.
Less Use of Diabetes Tech in Socioeconomically Deprived Areas
Uptake of diabetes technologies remains highly variable throughout the UK, with significantly lower use in people from socioeconomically deprived and minority ethnic groups, and this contributes to disparities in health outcomes, explained the researcher.
"We found that 46% of our service users were eligible for technology but not using it," Dr Ladwa said.
To understand more about the problem, and to improve access to diabetes technology by young adults living in the urban, inner city area of East London where she works, Dr Ladwa ran a two-part study that, firstly, reviewed the demographic profile of service users, and secondly piloted a community 'tech café' where service users were invited to a session run by peers and professionals aimed at promoting awareness and enabling role-modelling and peer support.
"In the Newham area, the majority of young people come from an ethnic background other than White British, and the proportion living in low-income families is much higher than the UK [generally]," said Dr Ladwa.
The cross-sectional retrospective study analysed data on service-users aged 18-25 with a diagnosis of type 1 diabetes. Data were collected from routine electronic health records and included age, sex, ethnicity, HbA1c levels, indices of multiple deprivation, treatment modality, and abbreviated diabetes-associated distress score.
"We chose this particular age group because these are the ones that are most often admitted with hypoglycaemic episodes, have high HbA1c levels, and who struggle with mental health and with self-management," she explained. She added: "It's a time of great change in young people's lives and [diabetes is a] great burden for these young people at highest risk."
Next, the community 'tech café' was piloted with the involvement of young people already using diabetes technology. All service users were invited to a drop-in evening session.
Over One-Third Increase in Diabetes Technology Uptake
A total of 80 service-users were included in the initial analysis (40 young women and 40 young men mean age 22.5 with mean HbA1c 77.6 mmol/mol). Over half were of either Asian or Black ethnicity, and almost 90% were from the most and second-most socially deprived segments of society.
Of those on multiple dose injections, 31 of 67 (46%) met eligibility criteria for a pump as per the NICE Technology Appraisal 151, but were not accessing therapy at the time.
The proportion of young adults with uncontrolled type 1 diabetes (HbA1c >86 mmol/mol) in Newham was 38%, compared with just over 25% nationally, and the uptake of diabetes technology was around 16%, below the national average of approximately 24%, said Dr Ladwa.
"This group of patients had a higher mean HbA1c of 90.3 mmol/L, and higher mean diabetes-associated distress score of 3.5," she added.
Following the community tech café, 5 in 6 service-users agreed or strongly agreed that they were now interested in trying diabetes technology. Six months post-pilot, six young people had newly commenced on an insulin pump, representing an overall increase in take-up of 33%, from around 16% to 24% reported Dr Ladwa.
Finally, she pointed out that: "The increase in technology uptake broadly reflected the demographics of the local type 1 diabetes population in terms of ethnicity and index of deprivation, demonstrating that more equitable take-up of diabetes technology can be achieved."
The study did not formally explore reasons for lack of uptake in the local population, but Dr Ladwa said some young people told her "doctor, that looks really good and interesting but it must cost a lot, I don't think you should spend that on me", reflecting possible issues with self-worth. Also, some women thought that they thought they would only be given a pump if they were good at managing their diabetes.
"This was a beginning not an end – a pilot – and we want to extend this. We are an ordinary general hospital, struggling with resources, but this was a simple intervention at low cost. I'd encourage other centres to do similar."
Could Low Technology Uptake Be Due to a Communication Problem?
Dr Bernadette Adeyileka-Tracz, PhD, is founder of Diabetes Africa, an organisation that aims to reduce diabetes inequalities and improve access to care for people of Black African and Black Caribbean heritage wherever they are in the world. "When we say 'there’s an uptake problem', we are putting all the burden on the populations who are receiving – or not – adequate care. But, perhaps, there’s also a problem of communication about diabetes technology," she pointed out.
"As healthcare professionals, we need to be more proactive and offer diabetes technologies to all people who qualify for it. The first thing to do is to ensure that people know that diabetes technology is available to them, and experience has showed that it is not always the case."
Dr Adeyileka-Tracz commented on the tech-café study. "Providing people living with diabetes and their families an opportunity to speak with their healthcare team outside the standard clinical setting, in a café or at an informal get-together for example, we see a huge improvement in access to technology. Information is better communicated and better received. A change of mindset, both for the healthcare team and people living with diabetes, encouraged by a change of setting, can help shape behaviours for the best.”
"Approaches such as the tech café could and should be tried in other regions where diabetes technology uptake is low," she said, adding: "Let’s be frank, what we’ve been doing so far is not working. The figures are there to prove it. So we should not be afraid to try new things."
Dr Tom Crabtree, diabetes registrar at Derby and Burton NHS Trust, also commented on Dr Ladwa's work. "This work recognises barriers to diabetes technology use that vary across the very many population sub-groups, with over 200 languages in a single London borough," he said.
"There is interesting technology for these groups but as doctors we often assume some people aren't interested in it, we make assumptions. We need to offer it to more people in clinic."
No funding was received from any commercial organisation to support this project. Dr Adeyileka-Tracz is founder of Diabetes Africa. Dr Crabtree has received speaker fees from Dexcom and Insulet. Dr Ladwa has received speaker's fees from Insulet.