Widening health inequalities related to type 1 diabetes care in children and young people in the UK: A time to act now

Ng, Sze May; Evans, Mark

doi:10.1111/dme.14620

Cited by 14 publications

(10 citation statements)

References 9 publications

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“…But this consistent improvement has masked widening health inequality with more deprived and ethnic minority children less likely to use insulin pumps or continuous glucose monitoring and more likely to have a higher HbA 1c . 6 The same signals are present in the adult National Type 1 Diabetes Audit. 7 We should applaud the success that is obvious in the paediatric data but we should perhaps be benchmarking the health equality gap as carefully as we do HbA 1c to ensure that opportunities to deliver targeted, personalised, effective care are not missed.…”

Section: E D I T O R I a L The Power Of Equalitymentioning

confidence: 86%

The power of equality

Oliver

2021

Diabet Med

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Section: E D I T O R I a L The Power Of Equalitymentioning

confidence: 86%

The power of equality

Oliver

2021

Diabet Med

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“…The relationship between the caregiver’s low SES, ethnicity, and HbA1c was previously reported [ 25 , 26 ] and both independently influenced metabolic control [ 26 ]. Regarding access to technologies, lower use of CSII or rtCGM in T1D children from minority ethnic communities has been previously associated [ 27 ] to higher HbA1c; in Italy these patients have not to pay for diabetes technologies, therefore, we speculate that probably in ethnic minority groups, school education and health literacy are still an important barrier to access to diabetes technologies, and new care models as the “mosaic clinic” have to be implemented to ensure equity in diabetes care and precision treatment [ 28 ]. Parental locus of control was more internal (parental) in the “optimal group”, as previously reported in pediatric patients [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Influence of Parental Health Locus of Control on Behavior, Self-Management and Metabolic Control, in Pediatric Patients with Type 1 Diabetes

Franceschi

Canale

Piras

et al. 2022

JPM

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Background: Precision medicine in type 1 diabetes (T1D) treatment considers context and environmental data to subclassify patients. Parental Health Locus of Control PHLOC) could influence behavior, self-management, and metabolic control of children with T1D. Methods: No. 135 pediatric patients with T1D (No. 57 with HbA1c ≤ 7.0%, “optimal” group, and No. 78 with >7.0%, “sub-optimal” group) were enrolled in the study. History, anthropometric and diabetes management data were collected, as well as caregiver’s data about socioeconomic status (SES). The PHLOC scale questionnaire and a semi-structured interview were administered. Results: Access to technology was lower in the “sub-optimal” group and, in particular, in the ethnic minority subgroup, only 8% used them. In the “sub-optimal” group ethnic minority status was higher (24%), the caregiver had a lower SES and showed lower internal HLOC. Conclusions: New care models have to be implemented to ensure equity in diabetes care and precision treatment, particularly for ethnic minority groups, because SES and external PHLOC are still an important barrier to “optimal” diabetes control. In the “sub-optimal” group, we have to implement strategies aimed at increasing self-efficacy, while in the “optimal” one, a personalised approach should be considered to facilitate the shifting of responsibilities within the family, avoiding psychological distress.

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“… 41 These disparities have lessened over the years but remain present. 42 , 43 Currently, real-time continuous glucose monitors (rt-CGMs) are reimbursed for type 1 patients and those with type 2 requiring intensive monitoring. 44 , 45…”

Section: Current Situationmentioning

confidence: 99%

The impact of socioeconomic factors, social determinants, and ethnicity on the utilization of glucose sensor technology among persons with diabetes mellitus: a narrative review

Been,

Lameijer,

Gans

et al. 2024

Therapeutic Advances in Endocrinology

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Continuous glucose monitoring (CGM) usage has been shown to improve disease outcomes in people living with diabetes by facilitating better glycemic management. However, previous research has suggested that access to these devices can be influenced by nonmedical factors such as socioeconomic status and ethnicity. It is critical that equitable access to CGM devices is ensured as people from those groups experience poorer diabetes-related health outcomes. In this narrative review, we provide an overview of the various healthcare systems worldwide and how socioeconomic status, social context, and ethnicity shape device usage and the associated health outcomes. In general, we found that having a lower socioeconomic status and belonging to an ethnic minority group negatively impact CGM usage. While financial means proved to be an important mediator in this process, it was not the sole driver as disparities persisted even after adjustment for factors such as income and insurance status. Recommendations to increase CGM usage for people of a lower socioeconomic status and ethnic minorities include increasing the availability of financial, administrative, and educational support, for both patients and healthcare providers. However, recommendations will vary due to local country-specific circumstances, such as reimbursement criteria and healthcare ecosystems.

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Widening health inequalities related to type 1 diabetes care in children and young people in the UK: A time to act now

Cited by 14 publications

References 9 publications

The power of equality

The power of equality

Influence of Parental Health Locus of Control on Behavior, Self-Management and Metabolic Control, in Pediatric Patients with Type 1 Diabetes

The impact of socioeconomic factors, social determinants, and ethnicity on the utilization of glucose sensor technology among persons with diabetes mellitus: a narrative review

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