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

AIMS: 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.

METHODS: 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 (HbA1c >75 mmol/mol) were analysed.

RESULTS: 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 HbA1c from 93 mmol/mol to 83 mmol/mol.

CONCLUSIONS: 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 HbA1c by 10 mmol/mol.