Addressing inequalities in access and care in type 1 diabetes - The North-East London Type 1 Diabetes Transformation (NATALIE) project.

Abstract

The North-East London Type 1 Diabetes Transformation (NATALIE) Project aimed to accurately provide data on place of care for people with type 1 diabetes (T1D) and assess the impact of interventions to engage people with T1D not accessing specialist care or those assigned to a high-risk register. Systematic searches were carried out to identify dual coding/no coding for type of diabetes and were followed by practice level case note review by a healthcare professional (HCP). The Clinical Effectiveness Group (CEG), which is a local primary care-led clinical academic group, was commissioned to aid with data searches. In City & Hackney, following the audit, the impact of pilot interventions was evaluated. These included a primary care toolkit, to improve engagement and of focused clinical care for those assigned to a high-risk register (HbA_1c >75 mmol/mol) were analysed. One hundred and fifty general practitioner (GP) practices engaged and 2499 patient records were reviewed. The proportion of people with T1D receiving care in primary care alone varied from 12.9 % to 37.7 % with a mean of 30 %. Following interventions including secondary care referral, referring for Freestyle Libre monitoring or structured education, the number of people with T1D under primary care alone reduced from 36 % to 24 %. The 85/133 people with T1D on the high-risk register who engaged with focused clinical intervention decreased their HbA_1c from 93 mmol/mol to 83 mmol/mol. In an area of high socioeconomic deprivation, the NATALIE project showed that an average of 30 % of people with type 1 diabetes are under primary care alone, and simple interventions improved this by up to 10 %. Furthermore, focused clinical contacts with high-risk people with T1D can reduce HbA_1c by 10 mmol/mol.