P-118: Does national provision of hybrid-closed-loop systems improve HbA1c and reduce health inequalities? a Scottish observational study
V Franklin, S Wild, S Williamson, E Bayman, C Webster, K Whyte, S Grosser, L Ferguson, K Bumke, B Rayen, E Clark, J Watt, S Philip, , Scottish Study Group for the Care of the Young with DiabetesAbstract
Introduction
Between June 2024 and March 2026, the Scottish Government funded universal access to Hybrid Closed-Loop Systems (HCLS) for all children and young people with type 1 diabetes.
Objectives
To examine the uptake and glycaemic impact of HCL-compatible combinations in children and young people across Scotland, and to study the impact on disparities related to socioeconomic deprivation.
Methods
All 0-17 year olds with a diagnosis of diabetes in Scotland are included in the SCI-Diabetes registry. The term “HCL-compatible combinations” (HCLCC) is used as the registry records pump and sensor use but not HCLS use. Population level data on HCLCC uptake and HbA1c were extracted for 0-17 year olds with type 1 diabetes in June 2024 and March 2026. Socioeconomic differences were examined using the area-based Scottish Index of Multiple Deprivation (SIMD).
Results
Uptake of HCLCC increased from 47% (1583/3406) in June 2024 to 80% (2711/3393) in March 2026. Over the same period median HbA1c decreased from 60 mmol/mol (IQR-19) to 58 mmol/mol (IQR-15).
In June 2024, 38% of individuals in the most deprived quintile were using HCLCC compared with 54% in the least deprived quintile. By March 2026, this gap had narrowed, with uptake rising to 74% in the most deprived quintile and 82% in the least deprived quintile.
Proportions of patients with HbA1c 75mmol/mol decreased from 18% to 13% overall (p<0.01) and from 24% to 20% (p<0.04) in the most and 11% to 9%(NS=0.1) in the least deprived quintiles.
Median HbA1c in 2024 was 63 mmol/mol in the most deprived quintile compared with 57 mmol/mol in the least deprived quintile. By 2026, this had reduced to 60 mmol/mol and 55 mmol/mol respectively, reducing the disparity by 17%.
Conclusions
Increased uptake of HCLCC was associated with a population-level reduction in median HbA1c. This study also highlights that nationally funded HCLS reduced health inequalities. However further improvements are required to achieve ISPAD glycaemic targets.