P-434: Youth workers as mentors for diabetes technology acceptance in the recalcitrant cohort
R Patel, C Bound, Z Mengistu, D N RayAbstract
Introduction
Type 1 Diabetes in children poses a large burden on health economics. 3233 new UK cases were diagnosed between April 2023 and March 2024,16% rise. NICE Technology Appraisal increased funding, with 55% using insulin pumps and 79% using real-time continuous glucose monitoring. Disparities persist, with higher HbA1c levels in lower socioeconomic areas. This NHS England-funded project evaluates barriers to technology uptake with youth worker support across Northwest London boroughs of Brent, Harrow, Hammersmith, Fulham and Hillingdon, with diverse populations and varying socioeconomic status
Objectives
To evaluate whether youth worker support in addition to existing multidisciplinary teams improves uptake of technology and glycaemic outcomes in CYP with T1DM
Methods
CYP with T1DM 11-18years, mean age 13, were enrolled in a 1-year programme across three Health Trusts.Participants were offered CGM with or without insulin pump therapy. Support was provided by youth workers from teaching and sports backgrounds trained by diabetic nurse champions. HbA1c and participant confidence in technology use were assessed via pre and postintervention surveys, alongside Youth worker experience
Results
23 participants were enrolled; 83% were from Black, Asian, and minority ethnic backgrounds. 65.2% lived in the most deprived deciles.Half agreed to use technology. Baseline mean HbA1c was 73 with 74% >60 and 13% >100. Post-intervention HbA1c >60 decreased to 60.1%, with one participant >100. Overall 53% demonstrated HbA1c reduction.
Conclusions
Multiple barriers to technology uptake were identified: device visibility stigma, cultural beliefs and bullying.Life stressors including exams and family circumstances impacted engagement and glycaemic control. Alongside MDT support, Youth worker liaison improved uptake, contributing to glycaemic improvement. This highlights significant external challenges in technology acceptance in CYPD and value of non-medical mentors engaging a recalcitrant cohort with systemic factors essential to optimise long-term outcomes.