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Aslam A, Chapman A, Urwin A, Ohol S, Thomas S, Gough R, Findlow LA, Lim J, Schofield J, Leelarathna L, Thabit H. Real-world data from first UK Omnipod 5 users: A single-centre observational study. Diabetes Obes Metab 2024. [PMID: 38698652 DOI: 10.1111/dom.15629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Aisha Aslam
- Diabetes, Endocrinology and Metabolism Center, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Alyson Chapman
- Diabetes, Endocrinology and Metabolism Center, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Andrea Urwin
- Diabetes, Endocrinology and Metabolism Center, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sheetal Ohol
- Diabetes, Endocrinology and Metabolism Center, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sonia Thomas
- Diabetes, Endocrinology and Metabolism Center, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rebecca Gough
- Diabetes, Endocrinology and Metabolism Center, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lynne-Ann Findlow
- Diabetes, Endocrinology and Metabolism Center, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jonathan Lim
- Diabetes, Endocrinology and Metabolism Center, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jonathan Schofield
- Diabetes, Endocrinology and Metabolism Center, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Lalantha Leelarathna
- Diabetes, Endocrinology and Metabolism Center, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Hood Thabit
- Diabetes, Endocrinology and Metabolism Center, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
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Fallon C, Jones E, Oliver N, Reddy M, Avari P. The impact of socio-economic deprivation on access to diabetes technology in adults with type 1 diabetes. Diabet Med 2022; 39:e14906. [PMID: 35751860 PMCID: PMC9544624 DOI: 10.1111/dme.14906] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/23/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND With advances in technology, there is an emerging concern that inequalities exist in provision and diabetes outcomes in areas of greater deprivation. We assess the relationship between socio-economic status and deprivation with access to diabetes technology and their outcomes in adults with type 1 diabetes. METHODS Retrospective, observational analysis of adults attending a tertiary centre, comprising three urban hospitals in the UK. Socio-economic deprivation was assessed by the English Indices of Deprivation 2019. Data analysis was performed using one-way ANOVAs and chi-squared tests. RESULTS In total, 1631 adults aged 44 ± 15 years and 758 (47%) women were included, with 391 (24%) using continuous subcutaneous insulin infusion, 312 (19%) using real-time continuous glucose monitoring and 558 (34%) using intermittently scanned continuous glucose monitoring. The highest use of diabetes technology was in the least deprived quintile compared to the most deprived quintile (67% vs. 45%, respectively; p < 0.001). HbA1c outcomes were available in 400 participants; no association with deprivation was observed (p = 0.872). Participation in structured education was almost twice as high from the most deprived to the least deprived groups (23% vs. 43%; p < 0.001). Adults with white or mixed ethnicity were more likely to use technology compared to black ethnicity (60% vs. 40%; p < 0.001). CONCLUSIONS Adults living in the most deprived quintile had less technology use. Irrespective of socio-economic status or ethnicity, glycaemia was positively affected in all groups. It is imperative that health disparities are further addressed.
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Affiliation(s)
- Ciara Fallon
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Emma Jones
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Diabetes and EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - Nick Oliver
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Diabetes and EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - Monika Reddy
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Diabetes and EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - Parizad Avari
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Diabetes and EndocrinologyImperial College Healthcare NHS TrustLondonUK
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Dover AR, Strachan MWJ, McKnight JA, Stimson RH, Mackenzie SD, Lyall MJ, Wright RJ, Forbes S, Gibb FW. Socioeconomic deprivation, technology use, C-peptide, smoking and other predictors of glycaemic control in adults with type 1 diabetes. Diabet Med 2021; 38:e14445. [PMID: 33128811 DOI: 10.1111/dme.14445] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/30/2020] [Accepted: 10/27/2020] [Indexed: 12/16/2022]
Abstract
AIMS Intensive glycaemic control is associated with substantial health benefits in people with type 1 diabetes. We sought to examine clinical and demographic factors associated with meeting glycaemic targets in type 1 diabetes. METHODS We conducted a cross-sectional analysis of 4594 individuals with type 1 diabetes. The primary outcome of the study was assessing factors associated with meeting HbA1c targets. Secondary endpoints included factors associated with continuous subcutaneous insulin infusion (CSII) use and persistent C-peptide secretion. RESULTS Socioeconomic deprivation was strongly associated with a lower likelihood of achieving an HbA1c <58 mmol/mol (7.5%) (20% in the most deprived quintile vs. 40% in the least deprived, p < 0.001). In multivariate analysis, absence of smoking history (OR 3.06, p < 0.001), flash monitoring (OR 1.49, p < 0.001), CSII (1.43, p = 0.022) and longer diabetes duration (OR 1.02 per year, p = 0.004) were independently associated with achieving HbA1c <58 mmol/mol (7.5%), whereas increasing age (OR 0.99 per year, p = 0.004) and C-peptide <50 pM (OR 0.58, p < 0.001) were associated with a lower likelihood of meeting this target. Low C-peptide (<50 pM) was less likely in men (OR 0.55, p < 0.001) and never smokers (0.44, p < 0.001) in multivariate analysis. CONCLUSIONS Lower levels of deprivation, non-smoking, higher C-peptide, technology use, lower BMI and male gender were all associated with a higher likelihood of meeting HbA1c targets. Access to proven diabetes treatments is lower in the most deprived individuals. Urgent efforts are required to provide treatments which are effective across the socioeconomic gradient.
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Affiliation(s)
- Anna R Dover
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Mark W J Strachan
- Edinburgh Centre for Endocrinology & Diabetes, Western General Hospital, Edinburgh, UK
| | - John A McKnight
- Edinburgh Centre for Endocrinology & Diabetes, Western General Hospital, Edinburgh, UK
| | - Roland H Stimson
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Scott D Mackenzie
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Marcus J Lyall
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rohana J Wright
- Edinburgh Centre for Endocrinology & Diabetes, St John's Hospital, Edinburgh, UK
| | - Shareen Forbes
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Fraser W Gibb
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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