Summary
The use of hybrid closed loop (HCL) and other diabetes technologies is linked to better management, outcomes, and quality of life. However, in Peterborough and North Cambridgeshire, access remains unequal – particularly among children and young adults from deprived and ethnic minority backgrounds. To address this, two dedicated roles were created within the Paediatric DSN team, focused on engaging these groups. Embedded within the diabetes care pathway, these roles have already improved uptake and ensure that access to advanced diabetes care is delivered equitably, meeting the diverse needs of the local population.
Innovation/Novel approach to an existing problem
Language barriers, cultural differences, and limited digital health literacy contributed to hesitancy, misunderstanding, and underutilisation of tools that could improve diabetes management and quality of life in deprived and ethnic minority families. Recognising that simply offering virtual clinics or translated leaflets would not address these deeply rooted disparities, a tailored, proactive, community-focused solution was developed. This involved the appointment of a Paediatric Diabetes Clinical Educator (PDCE) and a Paediatric Diabetes Care Technician (PDCT), with clearly defined roles to bridge this access gap in the multidisciplinary team (MDT). What set this initiative apart was its targeted structure, with the new roles actively identifying and engaging families in minority groups, particularly those facing language and cultural barriers. Engagement included personalised home visits, community outreach, and tailored, hands-on education sessions. Clinic pathways were adapted to include pre-appointment outreach and follow-up support in the family’s preferred language, often with the support technician as a consistent, trusted point of contact. Baseline data were established to understand existing rates of technology use by ethnicity and primary language. Ongoing metrics included: uptake rates of insulin pumps and CGMs HbA1c trends pre-/post-technology initiation; patient-reported outcome measures (PROMs); number and types of support delivered by the new staff; safety. This proactive, relationship-based model provided engagement and education, with embedded human support, co-designed with families, that adapted flexibly to language, cultural, and emotional needs. The introduction of dedicated roles, with built-in evaluation and continuous adaptation, made this initiative uniquely positioned to drive systemic change.
Equality, Diversity and Variation
A detailed local audit of the paediatric diabetes caseload across Peterborough and the surrounding areas explored equity in access to diabetes technology by stratifying patient data by ethnicity, language background, and geographic commissioning groups. The initial dataset (2022–23) of the 247 children and young people on the caseload showed: 94 (38.05%) were using insulin pumps and 148 (59.91%) were using real-time CGM. Within the Cambridgeshire & Peterborough ICB group, 54 out of 101 patients were on CGM (53.5%). In South Lincolnshire, 31 out of 38 (81.6%) were on CGM, suggesting wide regional variation. Among those identified as White British, 73 of 97 (75.3%) were using CGM and/or pump therapy. However, among Asian families, only 3 out of 7 were on technology, and for Black Other groups, just 2 out of 9 were using CGM or pumps. Similarly, within the White Other group only 11 out of 28 were using diabetes technology, pointing to lower engagement despite eligibility. Interviews with families for whom English was not the first language highlighted language barriers during device education sessions, cultural hesitancy around wearable technology, low digital health literacy, and lack of consistent, culturally aware follow-up.
Impact to Patient Care
The PDCT and PDCE roles not only increased the numbers using insulin pumps and CGM, but ensured that access was fairer and more inclusive. As of March 2025, 234 of the 304 patients (77%) were using insulin pumps, with 233 of those on HCL systems. CGM use rose to 93.5% from 59.9% a year earlier. Pathways were adjusted, waiting lists streamlined, and technology education was understandable, relevant, and culturally appropriate. This included group onboarding, translated guidance in multiple languages, and the use of platforms like DigiBete, which hosts multilingual videos and resources. Custom pump workbooks and device-specific training materials were developed. The PDCT and PDCE delivered weekly 1:1 and group onboarding sessions, supported every pump initiation, and helped families link to digital platforms. They worked with reps and the MDT to roll out new devices, respond to MHRA alerts, and support safe transitions. Since September 2023, 19 pump upgrades have been completed, and a new ketone/BG meter has been introduced. Keyworkers now have more time to focus on safeguarding and complex care needs.
Results
The recruitment of the PDCT in May 2023 and the PDCE in August 2023 were internally funded through cost reallocation within the existing team. In just 18 months, the project saw: insulin pump uptake increase from 38% to 77% (234 out of 304 patients), with 99.5% (233 patients) now using HCL technology. CGM usage rose to 93.5% (284 patients) from 59.9%. 19 pump upgrades and a full HCL rollout helped standardise high-quality care across the caseload. The project improved efficiency by streamlining pathways, reducing waiting times for pump and CGM starts, and optimising the MDT skill mix. Disjointed workflows were redesigned, ensuring patients were guided seamlessly from education to technology initiation, supported by newly developed translated workbooks, flowcharts, and structured onboarding clinics. Families who previously declined technology due to language barriers, mistrust, or lack of support became engaged, educated, and empowered. Early audit data showed HbA1c reductions averaging 0.9% in pump users started since August 2023. Emergency contacts and hypo-related A&E attendances decreased. Families reported increased confidence, reduced anxiety, and greater self-management ability, particularly in ethnic minority and non-English-speaking households. Uptake among Asian (80.5%), Black (83.3%), and White Other (73.6%) populations closely matched White British counterparts (85.9%). This model also reduced duplication. Reduced need for face-to-face appointments freed clinical capacity, increasing operational efficiency. Standardising education pathways reduced variation and prevented inefficiencies. Alignment with NHSE pilots and use of nationally endorsed platforms (e.g. DigiBete) ensured sustainability and scalability, without duplicating development costs. The model is recognised locally and regionally and serves as a blueprint for other paediatric diabetes services.
User Feedback
Families report greater confidence in managing diabetes, as captured through PROMs and informal feedback. Importantly, families describe feeling seen, heard and understood. MDT meetings now routinely include culturally informed discussions and flag patients who may need enhanced support.
