Despite Universal Healthcare, Diabetes Disparities Persists in the United Kingdom
Extensive data from the United Kingdom’s National Health Service (NHS) presented last month at the 2022 Advanced Technologies and Treatments for Diabetes (ATTD) conference shows socioeconomic barriers shape a person’s diabetes care.
The study, presented by Dr. Partha Kar, an NHS consultant on diabetes, shows that despite England’s universal healthcare, Black children with diabetes are half as likely as white children to use continuous glucose monitoring (CGM). This begs the question: Are advances in diabetes technology doing much good?
Kar would argue they could be doing better.
Universal healthcare should mean everyone with diabetes gets the same level of medical care and options for management tools, like an insulin pump, or continuous glucose monitor. Still, in the U.K., like in many other countries, that’s simply not the case.
By the numbers
CGM technology is a game-changer for many people with diabetes. Today’s leading CGM devices have been shown to help people with type 1 and type 2 diabetes lower their A1cs with consistent use, but not everyone who needs one is benefiting.
According to Kar, 40 percent of all children and youth living with type 1 diabetes (T1D) fall into the bottom two of five tiers of socioeconomic conditions.
“Every pediatrician worth their salt will tell you CGM is important, it changes lives. Parents say that’s the best thing that could have happened to them,” Kar said.
Despite the unequivocal benefit that CGM offers, it’s not getting into the hands of young people who need it most. Only 14 percent of the most at-risk children and young adults with T1D use CGMs, compared to over 25 percent among the most privileged group with T1D.
Access + insurance aren’t the only barriers
This detailed snapshot illustrated by the NHS data drives home that it’s more than just money and healthcare coverage that stand in the way of making diabetes care (and all healthcare) more equitable in the UK.
Kar questions, “Is it because the people don’t want it? Or is it because, structurally, we’ve put things in place, which makes it impossible to attend [required training]?”
Required, in-person CGM training introduces all sorts of barriers.
“They’re thinking, ‘You know what? I’m gonna not go. I don’t have money to pay for my car park. So I’m gonna skip this,’” Kar asked.
Some providers who haven’t considered the obstacles their patients face in their daily lives or their diabetes care may conclude: “You haven’t turned up, so you’re not worthy of getting the technology,” Kar said.
Understanding the barriers
The NHS data on adults with T1D and insulin pump use illustrates the same disturbing shortcoming.
Over 70,000 individuals eligible for an insulin pump aren’t using one. Why?
Barriers exist, we already know this, and studies in the United States have shown similar results.
A lack of proximity to a doctor’s office is a factor for many. Large parts of England are rural, meaning commuting time, access to reliable transportation and possibly extended waits to get an appointment with a provider can add to the process of getting a pump or CGM.
For many, work conflicts with daytime appointments with a doctor or diabetes educator. For some, this is just inconvenient, but it’s financially unfeasible for others.
Healthcare and medical fields aren’t immune to bias.
“Medical staff are a part of society. We are blighted by exactly the same ‘isms’ as everyone else,” Kar emphasized. “And that percolates into systems.”
Now, imagine you’re expected to attend multiple training sessions!
The compound effect of all these forces is stark: “The picture is the same across the board—if you come from a poorer background, you do not get the technology,” Kar said.
It’s not all bad news.
The NHS set ambitious targets in 2019 for improving access to diabetes technology, and many were met or exceeded.
Nearly all pregnant people living with diabetes (98 percent) have access to CGMs, and 60 percent of all people living with type 1 diabetes have access to FreeStyle Libre devices. This blew the initial 20 percent goal out of the water.
That reach is undoubtedly impressive. But these improvements haven’t reached all parts of the population equally.
What needs to change in the U.K.
Kar is putting this new data to good use to push for accountability and change, not just in healthcare systems but also in industry partners.
“You may not know the data, fine, but if you know the data and are not doing anything about the data, then you have a problem,” Kar said.
Data from all U.K. hospitals will be made public starting in 2023.
Kar is adamant it is not just the job of healthcare professionals to solve inequalities.
He called on the diabetes industry to commit to not just work on the diabetes technology but to get serious about making it accessible and move the needle on the state of diabetes care.
“Have we been our worst enemy going? Have we made technology so specialized that only a select few people can use it?” Kar said.
The solution? Change the paradigm—education paradigm—around diabetes tech. Offer education alongside the technology. Not before.
“Technologies are part and parcel of type 1 diabetes care. You have to prescribe it just like you prescribe glucose strips. End of story. Get on to it.
“Let’s get things moving.”