A retrospective review of clinical records from the Waikato Regional Diabetes Database in December 2017 concluded that poor glycaemic control in patients with type 1 diabetes mellitus was likely due to inequities in healthcare, including reduced access to insulin pump therapy. A total of 1303 patient records were examined, and glycaemic control was determined by the most recent glycosylated haemoglobin (HbA1c) reading in the past 2 years. Median HbA1c was 67 mmol/mol (8.3%), and was above the recommended range in 85.3% of patients. When analysed according to age, median HbA1c was highest in patients aged 15–29 years. Patients on insulin pump therapy had lower median HbA1c than those receiving multiple daily injections (63 mmol/mol [7.9%] versus 69 mmol/mol [8.5%]; p<0.001). Insulin pumps were significantly less likely to be used by Māori (p=0.003) and men (p<0.0001). Worsening glycaemic control was associated with increasing social deprivation (p<0.001) but not with rural/urban living.
The few people I know with type 1 diabetes mellitus tell me that new technologies, such as e-testing and insulin pumps, are both life-changing and expensive. This study demonstrates inequitable access to these interventions by ethnicity and ‘deprivation’ status, with potential impact on clinical outcomes. We must advocate for equitable access to new, effective interventions.
Independent commentary by Dr. Matire Hardwood
Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.
Research Review publications are intended for New Zealand health professionals.
Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.
