Glycaemic Control by Sociodemographic Factors in Adults With Type 1 Diabetes in England: Trends From 2007–2008 to 2023–2024

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AIMS: This study evaluated trends in glycaemic control in adults with Type 1 diabetes in England from 2007-2008 to 2023-2024, stratified by age, sex, ethnicity and socioeconomic deprivation. MATERIALS AND METHODS: Adults aged ≥ 20 years from the National Diabetes Audit were analysed. Trends in mean HbA1c were assessed using linear mixed-effects models. Logistic regression examined associations between sociodemographic factors and having an HbA1c ≤ 58 mmol/mol (≤ 7.5%); odds ratios were converted to relative risks. RESULTS: In 2007-2008, 32.6% of 133 035 adults had an HbA1c ≤ 58 mmol/mol, increasing to 39.1% of 226 005 adults in 2023-2024. Mean HbA1c declined from 68.8 (95% CI: 68.6-69.0) to 66.2 mmol/mol (95% CI: 66.1-66.3). By age, the largest improvement occurred in those aged 20-24 years, from 76.7 to 70.1 mmol/mol (p < 0.001), while adults > 64 years saw a non-significant increase from 63.7 to 63.8 mmol/mol (p = 0.203). Women consistently had higher mean HbA1c than men (2023-2024: 66.1 vs. 65.8 mmol/mol), declining from 69.4 to 66.1 mmol/mol in women and from 68.4 to 65.8 mmol/mol in men (both p < 0.001) and a lower adjusted probability of threshold attainment (38.4% [95% CI: 38.0-39.4] vs. 38.7% [95% CI: 38.2-39.3]). Marked ethnic inequalities persisted in 2023-2024: mean HbA1c was highest in Black (72.1 mmol/mol, 95% CI: 71.5-72.7) and Asian adults (69.8 mmol/mol, 95% CI: 69.4-70.2) compared with White adults (65.3 mmol/mol, 95% CI: 65.1-65.5). Socioeconomic gradients remained substantial, with threshold attainment at 46.4% (95% CI: 45.6-47.2) in the least deprived versus 32.3% (95% CI: 31.4-33.9) in the most deprived group. CONCLUSIONS: Although HbA1c improved overall, inequalities by age and deprivation widened, highlighting the need for equitable targeted care.

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