Prescription distribution and inequities in diabetes care: A comparative analysis of continuous glucose monitoring access by diabetes status, ethnicity and socio-economic factors in England

IF 3.4 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine Pub Date : 2025-09-03 DOI:10.1111/dme.70130

Samuel Seidu, John Tetteh, Setor Kunutsor, Pratik Choudhary, Kamlesh Khunti, Ramzi A. Ajjan

{"title":"Prescription distribution and inequities in diabetes care: A comparative analysis of continuous glucose monitoring access by diabetes status, ethnicity and socio-economic factors in England","authors":"Samuel Seidu, John Tetteh, Setor Kunutsor, Pratik Choudhary, Kamlesh Khunti, Ramzi A. Ajjan","doi":"10.1111/dme.70130","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Diabetes affects over 3.3 million people in England, creating a significant health and economic burden. Continuous glucose monitoring (CGM) improves diabetes management but remains unevenly accessible, especially among Black and minority groups who face onset at younger ages, higher diabetes rates and complications. Updated NICE guidelines promote CGM access for all people with T1D and certain people with T2D, yet data on prescribing patterns in England are limited. This study investigates CGM prescribing across integrated care boards (ICBs) and primary care networks (PCNs), focusing on ethnicity and deprivation, to identify and address access disparities.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Cross-sectional analysis of publicly available data examined CGM prescribing patterns across England's PCNs, focusing on ethnicity and socio-economic factors. Data from OpenPrescribing, the National Diabetes Audit and Public Health England were analysed through descriptive and inferential statistics, including regression and Intraclass Correlation Coefficient (ICC) calculations, to assess disparities in prescribing ratio per 1000 people.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Significant disparities in CGM prescribing across PCNs and ICBs are identified, shaped by ethnicity, age and socio-economic factors. The mean items prescription ratio is 4.87 per 1000 people, ranging from 0.26 to 11.59. People with T1D are generally younger, with only 15.5% over 65, compared to 52.0% in T2D. White individuals represent 83.6% of T1D cases, while South Asians and Afro-Caribbeans are more prevalent in T2D (14.5% and 5.3%, respectively). ICBs with below-average CGM prescribing have a higher percentage of Afro-Caribbean and South Asian populations compared to ICBs with above-average prescribing. For T1D, Afro-Caribbean representation is 6.7 (SD:7.0) in lower-prescribing ICBs versus 2.1 (SD:2.8) in higher-prescribing ICBs, and for T2D, it is 8.4 (10.4) versus 1.8 (SD:3.4) South Asian representation in low-prescribing ICBs is 10.6 (SD:13.7) for T1D and 21.9 (SD:20.5) for T2D, compared to 3.2 (SD:4.9) for T1D and 6.5 (SD:9.7) for T2D in higher-prescribing ICBs. CGM prescribing variance attributed to ethnicity and deprivation is 46.6% in T1D and 77.3% in T2D, indicating considerable socio-demographic impact.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>This study reveals significant ethnic disparities in CGM access, with Afro-Caribbean and South Asian groups facing a reduced prescribing ratio per 1000 people. Consistent NICE guideline adoption and targeted outreach are needed to improve equity in CGM access.</p>\n </section>\n </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 11","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70130","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetic Medicine","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/dme.70130","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Diabetes affects over 3.3 million people in England, creating a significant health and economic burden. Continuous glucose monitoring (CGM) improves diabetes management but remains unevenly accessible, especially among Black and minority groups who face onset at younger ages, higher diabetes rates and complications. Updated NICE guidelines promote CGM access for all people with T1D and certain people with T2D, yet data on prescribing patterns in England are limited. This study investigates CGM prescribing across integrated care boards (ICBs) and primary care networks (PCNs), focusing on ethnicity and deprivation, to identify and address access disparities.

Methods

Cross-sectional analysis of publicly available data examined CGM prescribing patterns across England's PCNs, focusing on ethnicity and socio-economic factors. Data from OpenPrescribing, the National Diabetes Audit and Public Health England were analysed through descriptive and inferential statistics, including regression and Intraclass Correlation Coefficient (ICC) calculations, to assess disparities in prescribing ratio per 1000 people.

Results

Significant disparities in CGM prescribing across PCNs and ICBs are identified, shaped by ethnicity, age and socio-economic factors. The mean items prescription ratio is 4.87 per 1000 people, ranging from 0.26 to 11.59. People with T1D are generally younger, with only 15.5% over 65, compared to 52.0% in T2D. White individuals represent 83.6% of T1D cases, while South Asians and Afro-Caribbeans are more prevalent in T2D (14.5% and 5.3%, respectively). ICBs with below-average CGM prescribing have a higher percentage of Afro-Caribbean and South Asian populations compared to ICBs with above-average prescribing. For T1D, Afro-Caribbean representation is 6.7 (SD:7.0) in lower-prescribing ICBs versus 2.1 (SD:2.8) in higher-prescribing ICBs, and for T2D, it is 8.4 (10.4) versus 1.8 (SD:3.4) South Asian representation in low-prescribing ICBs is 10.6 (SD:13.7) for T1D and 21.9 (SD:20.5) for T2D, compared to 3.2 (SD:4.9) for T1D and 6.5 (SD:9.7) for T2D in higher-prescribing ICBs. CGM prescribing variance attributed to ethnicity and deprivation is 46.6% in T1D and 77.3% in T2D, indicating considerable socio-demographic impact.

Conclusion

This study reveals significant ethnic disparities in CGM access, with Afro-Caribbean and South Asian groups facing a reduced prescribing ratio per 1000 people. Consistent NICE guideline adoption and targeted outreach are needed to improve equity in CGM access.

Abstract Image

查看原文本刊更多论文

糖尿病护理中的处方分布和不公平：英国糖尿病状况、种族和社会经济因素对连续血糖监测获取的比较分析

背景：在英国，糖尿病影响着超过330万人，造成了巨大的健康和经济负担。持续血糖监测（CGM）可改善糖尿病管理，但可及性仍不均衡，特别是在黑人和少数族裔群体中，他们的发病年龄更小，糖尿病发病率和并发症更高。更新后的NICE指南促进所有T1D患者和某些T2D患者使用CGM，但英格兰关于处方模式的数据有限。本研究调查了综合护理委员会（icb）和初级保健网络（pcn）的CGM处方，重点关注种族和剥夺，以识别和解决获取差异。方法：对公开数据进行横断面分析，检查英格兰pcn的CGM处方模式，重点关注种族和社会经济因素。通过描述性和推断性统计，包括回归和类内相关系数（ICC）计算，对来自OpenPrescribing、国家糖尿病审计和英国公共卫生的数据进行分析，以评估每1000人处方比例的差异。结果：在pcn和icb之间发现了CGM处方的显著差异，这种差异受种族、年龄和社会经济因素的影响。平均项目处方比为每千人4.87，范围为0.26 ~ 11.59。T1D患者普遍较年轻，65岁以上的患者仅占15.5%，而T2D患者占52.0%。白人占T1D病例的83.6%，而南亚人和非洲-加勒比人在T2D中更为普遍（分别为14.5%和5.3%）。与处方水平高于平均水平的ICBs相比，CGM处方水平低于平均水平的ICBs的非裔加勒比人和南亚人口比例更高。对于T1D，非洲裔加勒比人在低处方ICBs中的代表性为6.7 (SD:7.0)，而在高处方ICBs中为2.1 (SD:2.8)，对于T2D，为8.4（10.4）和1.8 （SD:3.4）。南亚人在低处方ICBs中的代表性为T1D 10.6 （SD:13.7）和T2D 21.9 (SD:20.5)，而在高处方ICBs中，T1D为3.2 （SD:4.9）和T2D为6.5 （SD:9.7）。种族和贫困导致的CGM处方差异在T1D中为46.6%，在T2D中为77.3%，表明相当大的社会人口影响。结论：本研究揭示了在CGM获取方面存在显著的种族差异，非洲-加勒比和南亚群体面临着每1000人的处方比例降低。需要一致采用NICE指南和有针对性的外展活动，以改善CGM获取的公平性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Diabetic Medicine 医学-内分泌学与代谢

CiteScore

7.20

自引率

5.70%

发文量

229

审稿时长

3-6 weeks

期刊介绍： Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”