P-150: National hybrid closed loop implementation: uptake and glycaemic outcomes in children with type 1 diabetes at pre-funded pilot sites aimed at reducing inequalities, compared to non-pilot sites
S Hulikere, N WildeAbstract
Introduction
Hybrid closed loop (HCL) technologies improve glycaemic control in children and young people (CYP) with Type 1 diabetes. NHS England funded Diabetes Technology Pilots at 44 sites during national HCL rollout to increase access in deprived groups and address health inequality. Regional leadership selected sites based on low uptake of technology in CYP and high deprivation. We assessed HCL uptake and glycaemic outcomes in pilot and non-pilot trusts.
Objectives
To compare HCL implementation and glycaemic outcomes in pilot vs non-pilot trusts using National Paediatric Diabetes Audit (NPDA) data.
Methods
Retrospective analysis of NPDA data from 157 English trusts across pre-pilot (2021/22), pilot (2022/23-2023/24), and post-pilot (2024/25) periods. Outcomes were HCL use, mean HbA1c, and HbA1c ≤48 and ≥69 mmol/mol. Trusts were classified as pilot (n=44) or non-pilot (n=113). Deprivation was assessed using index of multiple deprivation.
Results
Across England, HCL use increased by 17412 CYP between 2021-2025. Mean HbA1c decreased by 2.72 mmol/mol. Non-pilot trusts increased HCL use by 55.0 percentage points (HbA1c reduction of 2.4 mmol/mol). Proportion of CYP with HbA1c ≤48 mmol/mol rose from 12.4% to 13.9%. Those ≥69 mmol/mol fell from 27.4% to 21.0%. Pilot trusts increased HCL use by 56.8 percentage points (HbA1c reduction of 3.4 mmol/mol). Proportion of CYP with HbA1c ≤48 mmol/mol rose from 11.9% to 12.8%. Those ≥69 mmol/mol fell from 29.9% to 21.7%. Pilot sites served more deprived populations (29.2% vs 20.1% in the most deprived quintile).
Conclusions
Pilot trusts showed greater HbA1c reduction, suggesting more effective use of HCL or enhanced support. Pilot trusts achieved slightly lower HbA1c ≤48 mmol/mol but a larger reduction in HbA1c ≥69 mmol/mol, indicating stronger impact in higher-risk groups. HCL uptake increased similarly across trusts. Pilot sites sustained implementation despite higher deprivation. Targeted technology pilots during implementation supported improved uptake and outcomes.