Summary
Advancing Equity in Diabetes Technology, a toolkit by Diabetes Africa, was launched in November 2024 and provides a unique resource to increase the use of diabetes technology in UK Black, African and African-Caribbean populations. It is accessible at: https://diabetesafrica.org/technology-toolkit/
Innovation/Novel approach to an existing problem
The uptake of diabetes technology in Black people with type 1 diabetes in England and Wales is the lowest of all ethnic groups, below even that of the most socioeconomically deprived quintile. The toolkit was developed to address this specific need, both as a call to action and as a practical guide. The team believes there is no equivalent project in the UK which focuses specifically on Black African and African-Caribbean populations, offering practical solutions for healthcare professionals (HCPs) working in diabetes. The toolkit has a self-assessment checklist, followed by chapters on data analysis, goal setting, implementation and evaluation. The approach is supportive and constructive, grounded in the experience of HCPs, service users and their families, and NHS decision makers. The checklist helps teams evaluate their current practice and identify opportunities for improvement. Importantly, it recognises that inequalities are structural as well as individual, so provides guidance not only for frontline practitioners, but also for NHS managers and commissioners. The objective of the resource is to eliminate the gap in diabetes technology usage between Black and White children and adults with type 1 diabetes in England and Wales by 1 November 2030.
Equality, Diversity and Variation
The Newham Adult Type 1 Diabetes service cares for a large number of patients from Black African and African-Caribbean backgrounds, yet none was using insulin pump therapy. Poor outcomes were recognised in the local Black population with type 1 diabetes, particularly in terms of numbers of admissions with diabetic ketoacidosis and rate of progression to end-stage renal failure. The team used the toolkit to identify a lack of clarity in the service’s technology pathway and a lack of community presence. Goals were set using the toolkit and a tech café project was implemented, with a focus on hybrid closed loop (HCL) systems in type 1 diabetes. Following the project, 16 adults of Black African and Black Caribbean ethnicity became users of HCL systems. After six months on HCL, there were no longer significant differences in HbA1c, time-in-range, or diabetes-associated distress compared with their peers. The cohort had improved as a whole and the ethnic gap had narrowed.
Impact to Patient Care
The toolkit provides a framework through which patient care can be enhanced, both at local and national levels. In the Newham case study, patient care improved both in terms of clinical endpoints and reduction of inequalities. The toolkit implemented a better relationship between patients and the healthcare team. The tech café was a proactive, positive approach to offering diabetes technology, helping to build trust and understanding on both sides. The result was improved patient satisfaction and, often, transformative change. In another example, Alliance Teaching Practices, part of Coventry and Rugby GP Alliance, via the toolkit, used EMIS to identify eight individuals of Black ethnicity living with T1D who were eligible for but not accessing CGM. This demonstrates how the toolkit works in a primary care setting.
Results
In the Newham University Hospital, Barts Health NHS Trust example mentioned, following feedback from service user focus groups and collaboration with industry and charitable organisations, a community outreach project was undertaken: the ‘tech café’. Service users and their families attended drop-in sessions at a local coffee shop, to look at demo devices and talk to patient volunteers and staff. The idea was to create a welcoming environment in an informal, non-clinical setting and to foster engagement through peer support and networking. Service users of all ethnicities were invited and a diverse representation of patient volunteers were involved, promoting inclusivity. Several events were piloted, with the flagship event of January 2025 receiving highly positive responses. At six months post-event, not only had the total number of adults with type 1 diabetes using HCL increased by 33%, but 20% of them (n=16) were of Black African or Black African-Caribbean ethnicity. Analysis of patient outcomes at six months demonstrated clinical improvements for all new users of HCL, as well as showing a narrowing of the gap in outcomes between Black patients and their peers. At baseline, HbA1c was higher in Black HCL starters (68 vs 63mmol/mol), time-in-range was lower (41 vs 48%) and diabetes-associated distress scores were higher in the Black population compared to average (4.0 vs 3.3). After six months on HCL, Black users had caught up with their peers in all domains; HbA1c (54 vs 53mmol/mol), time-in-range (70% vs 71%) and diabetes-associated distress (3.3 vs 3.0). This case study illustrates an important point. The toolkit’s approach to improving clinical outcomes and enhancing the patient experience for Black African and African-Caribbean individuals living with diabetes does not imply the exclusion of other demographic groups, nor does it result in their deprioritisation or adverse impact. On the contrary, the intervention yielded benefits for all. This evidence will encourages HCPs to regard the reduction of healthcare inequalities not as an optional addition, but as a fundamental and integral component of elevating the overall quality of care.
User Feedback
Since its launch, in seven months, the toolkit has been downloaded over 3,500 times. In a survey of those who had downloaded it, 100% said they would recommend it to a colleague or friend. This demonstrates that the toolkit is effective in supporting teams to identify and target areas of challenge regarding diabetes technology uptake in UK Black populations. Following the Newham tech café initiative, their charitable partner Breakthrough T1D collected anonymous feedback from 50 people (including people with type 1 diabetes, their friends and families) who attended the event, which earned an average of 4.8 out of 5. All respondents felt more knowledgeable about managing T1D in different ways after attending. Many expressed interest in future events. The Breakthrough T1D team stated, “The T1D Tech Café exceeded expectations in attendance, impact, and overall reception. It served as an excellent introduction for newcomers and strengthened the sense of community among attendees.”
