title: Deprivation and ethnicity impact on diabetes control and use of treatment regimen.
abstract: OBJECTIVE
  Deprivation and/or ethnicity impact on care delivery. We have assessed how these factors influence diabetes care in a paediatric clinic.
  
  
  METHODS
  We related access to care [type of insulin treatment regimen-twice daily, multiple daily injections and insulin pump therapy (continuous subcutaneous insulin infusion)], measures of care process (HbA(1c)) and an approximate measure of satisfaction with the service (clinic attendance rate) in 325 (170 male) children and young people with Type 1 diabetes (mean age 10.6 years, mean duration of diabetes of 4.5 years), with indices of deprivation and ethnicity.
  
  
  RESULTS
  Of the 325 children and young people, 2.7% received twice-daily insulin, 48.4% multiple daily injections and 48.9% continuous subcutaneous insulin infusion. Median clinic HbA(1c) was 62 mmol/mol (7.8%) and those receiving the insulin pump therapy had the lowest HbA(1c). Four ethnic groups were represented; White British 81.6%, Asian non-Indian 6.5%, African 8.1% and Asian Indian 3.8%. Mean deprivation score was 21.06. White British and Asian Indian groups were more likely to receive insulin pump therapy (χ(2) = 50.3; P < 0.001). Attendance rates were 94.1% and did not differ across ethnic groups. Deprivation was related to ethnicity and HbA(1c) (R(2) = 0.02; P = 0.02). There was no relationship between clinic attendance and deprivation. Insulin regimen and ethnicity were associated with HbA(1c) (R(2) = 0.096; P < 0.001). Similar findings were obtained when analysis was confined to the White British population.
  
  
  CONCLUSIONS
  These data suggest that deprivation and ethnicity influence diabetes control and how intensive insulin therapy is utilized. A better consideration of the needs of different ethnic groups is required to ensure equitable care delivery in paediatric diabetes.
authors.affiliation: Children and Young People's Diabetes Service, University College London Hospitals, London, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Thompson
authors.forename: K
authors.initials: K
authors.lastname: Agostini
authors.forename: L
authors.initials: L
authors.lastname: Potts
authors.forename: J
authors.initials: J
authors.lastname: Luscombe
authors.forename: D
authors.initials: D
authors.lastname: Christie
authors.forename: R
authors.initials: R
authors.lastname: Viner
authors.forename: B
authors.initials: B
authors.lastname: White
authors.forename: P C
authors.initials: PC
authors.lastname: Hindmarsh
mesh_terms: D000349:Africa / Q000208:ethnology; D001208:Asia / Q000208:ethnology; D002648:Child; D003695:Delivery of Health Care / Q000208:ethnology / Q000592:standards; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000208:ethnology; D004334:Drug Administration Schedule; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007279:Injections, Subcutaneous; D007332:Insulin Infusion Systems; D061385:Insulins / Q000008:administration & dosage*; D008297:Male; D017060:Patient Satisfaction / Q000208:ethnology / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D061385:Insulins