Diabetes and Deprivation Index; Assessment of Changes Over Time in Control and Therapeutics

Aim: To assess how differences in socioeconomic status are related to diabetes control and access to/uptake of therapeutics over time in an Irish paediatric diabetes centre. Method: Data was extracted from a review of the scanned clinic records of of all patients under the active care of University Hospital Limericks (UHL) paediatric diabetes service from 2024 to 2025. Data was cross referenced with the 2022 Pobal HP Deprivation Index, an Irish measure of geographical deprivation derived from multiple social and econonic variables updated every 5 years. Paired and multivariate panel analysis was performed to relate glycaemic control (HbA1c and Time in Range TIR), diabetic ketoacidosis (DKA), listing on the hospital at risk program (HARP) which necessitates closer management of higher risk patients, treatment regimen and deprivation. Results: Data of 218 patients with data in 2024 and 2025. Average HbA1c rose for those from the most deprived areas, 0.21% (p=0.19) while other groups fell -0.01% to -0.30%. TIR also disimproved for the most deprived group, -4.51% (p=0.13), while improving for all other groups (+0.05% to +1.77%). Rates of DKA fell dramatically across all groups from 2024 to 2025, this was independent of deprivation group. The proportion of patients in the most deprived group using insulin pump therapy increased from 40% to 42.5%, usage for the least deprived increased from 59.1% to 63.6%. In panel analysis, the primary explanatory factor for change in HbA1c between 2024 and 2025 was commencement of insulin pump therapy, those who commenced pump therapy saw a fall in HbA1c of -1.2% (p<0.01) controlling for all other variables. Once insulin regimen was accounted for, there was no statistically significant difference between deprivation groups. HbA1c for those on pump therapy was 1.00% (p<0.01) lower than non-pump therapy in 2024 and 0.95% (p<0.01) lower in 2025. Conclusion: Average glycaemic control showed an overall improvement in this cohort with the exception of those from the most deprived areas. Differences in access to and uptake of pump therapy were found to exist with slower uptake of pump therapy in the most deprived group. These differences are the most important contributory factor to glycaemic control differences, whether measured by HbA1c or Time in Range. Common reasons for not commencing insulin pump therapy may be issues with compliance, emergency contingency planning, and potential issues with financial resources to facilitate a higher number of clinic visits and education sessions. This study suggests potential value from an exploration into factors affecting pump access and uptake in lower socioeconomic groups and potential additional resource allocation to address these health inequalities. A specific analysis of the significant drop in DKA admissions over the reference period also warrants futher investigation.