New research has revealed stark and worsening inequalities in type 1 diabetes outcomes. The analysis shows that while there have been marked improvements in blood sugar levels among adults living in the least deprived areas in recent years, those from the most deprived areas have seen no progress.
The findings have been presented at our Diabetes UK Professional Conference 2025.
Researchers from Imperial College London analysed data from the National Diabetes Audit (NDA), a major clinical audit conducted by NHS England in partnership with Diabetes UK. The team looked at trends in HbA1c levels from 2007 to 2023, in adults living in England with type 1 diabetes.
For most people with diabetes, an ideal HbA1c is 48mmol/mol or below. Having a HbA1c higher than 58 mmol/mol increases the risk of serious long-term complications.
The new findings highlight that while the overall percentage of adults with an HbA1c above 58 mmol/mol has declined from 72% in 2007 to 68% in 2023, not everyone is benefiting equally.
- In the most deprived areas, the percentage of adults with type 1 diabetes with HbA1c levels above 58 mmol/mol increased from 69% in 2007 to 70% in 2023.
- Meanwhile, in the least deprived areas, this figure dropped from 65% to 56% over the same 16-year period.
This means that by 2023, 70% of adults with type 1 diabetes in the most deprived areas had markedly high blood sugar levels, compared to 56% in the least deprived areas.
While the prevalence of type 1 diabetes is similar across all social groups, inequalities exist in how the condition impacts long-term health. A study of the Scottish type 1 diabetes population estimated that those living in the most deprived areas would develop diabetes complications five years sooner and die eight years earlier than those living in the least deprived areas.
Many factors are likely to contribute to the deprivation gap in type 1 diabetes outcomes. For example, recent NDA analysis showed adults with type 1 in the least deprived areas were more likely to receive all eight essential diabetes care checks and to use diabetes technology than those in the most deprived communities.
To help all people with type 1 diabetes live longer, healthier lives and avoid devastating complications, we’re calling for improved access to comprehensive, regular diabetes care, including fair access to technology.
Helen Kirrane, Head of Policy and Campaigns at Diabetes UK, said:
“This new analysis lays bare the stark and widening inequalities that persist for adults with type 1 diabetes, with those from more deprived backgrounds being left behind.
“Last year, the Darzi Review highlighted the unacceptable inequalities in access to essential care for people with type 1 diabetes. The Government must take action to address this issue in the NHS’s forthcoming 10-year health plan.”
Dr Naomi Holman, Research Fellow in Epidemiology and Intervention Effectiveness at Imperial College London, said:
“This work shows that whilst blood glucose management has improved for adults with type 1 diabetes as a whole, the change has not been equal across everyone.
"This highlights the need to look beyond high-level figures and investigate how care and outcomes change across different sections of the population, and to consider how changes in policy or healthcare delivery may improve or widen existing health inequalities.”
