Tackling inequalities in diabetes care for children and young people

12 Nov 2026

This World Diabetes Day, on 14 November 2026, we share how the National Paediatric Diabetes Audit is supporting healthcare providers to provide equitable care.

Living with diabetes places significant demands on children and their families. Alongside the daily clinical challenges of managing the condition, families often face additional financial pressures stemming from reduced working hours and income, as well as inequalities in care such as variation in access to diabetes technology. That’s why the National Paediatric Diabetes Audit (NPDA), commissioned by the Healthcare Quality Improvement Partnership (HQIP) and delivered by the Royal College of Paediatrics and Child Health (RCPCH), is helping care providers to understand – and address – these issues.

77% of people living with diabetes say that the rising cost of living is negatively impacting how they manage their condition” Diabetes UK

A recent Children North East report estimated that the average out-of-pocket monthly cost of caring for a child with diabetes is more than £425, due to the additional costs incurred such as travel, specialist food and equipment, and time away from work. This is backed up by the NPDA’s work, which found that 30% of carers reported that they or their partner reduced their working hours following their child’s diagnosis. 11% said that they or their partner had even left employment altogether.

These findings demonstrate why addressing health inequalities is critical, as some families will inevitably be greatly impacted by these issues. By identifying variation in access, care and outcomes, the NPDA gives healthcare providers the evidence they need to target improvement where it will have the greatest impact. However, they are going a step further, by working with the sector to proactively reduce the barriers created by poverty. They are delivering training across the country, through a programme known as Poverty Proofing®, and they are supporting more equitable access to hybrid closed loops (HCL) – a technology that considerably reduces the need for regular manual monitoring and insulin adjustment.

Going national with Poverty Proofing® on diabetes care

Children North East (CNE) developed Poverty Proofing® to help health services understand how poverty affects patients’ access, participation and experience of care. This programme uses staff training, consultation and evidence-based guidance to identify changes that services can make to reduce financial barriers, and improve equitable access. The NPDA has been working with CNE to deliver a national Poverty Proofing® programme aimed at all 11 Children and Young People’s Diabetes Networks in England and Wales. Between January 2025 and April 2026, they delivered 24 workshops, with more than 925 staff working in paediatric diabetes services taking part. Covering topics such as barriers affecting access to appointments, treatment and technology, and using NPDA data to identify inequalities, these workshops raise awareness of the issues faced by families and help teams develop action plans for delivering equitable care.

Practical actions identified through the workshops included routinely asking families whether financial pressures affect diabetes management, and signposting them to food support, housing services and debt advice. Teams also looked closely at aspects of care that can create additional costs or difficulties for families, and included actions such as offering appointments in more accessible locations, and providing evening or satellite clinics, in their plans.

These are seemingly simple changes, but they are the difference between effective care, and not, for many families; they are a lifeline in many instances”

One of the paediatric diabetes teams involved in this work describes the difference it was making to families: “In one case, where we were struggling to get the family to engage in diabetes management, we discussed whether the financial impacts of travelling to clinic were a factor. We were able to offer support for travels costs, discussed financial pressures during clinic appointments, and subsequently referred them to a local food bank.”

Another service introduced three Poverty Proofing questions into its annual review process, developed a financial support leaflet, and used charities to provide mobile phones to families who needed them. It also asked GPs to prescribe items such as hypoglycaemia treatments and adhesive removers, reducing the costs that families might otherwise face.

These are seemingly simple changes, but they are the difference between effective care, and not, for many families; they are a lifeline in many instances. Financial hardship can be difficult for both families and healthcare professionals to discuss. Staff can worry about embarrassing families, but this training programme produced a notable change in knowledge and confidence. Before the training, 70% of participants reported a “good understanding” of poverty, while only 36% said they felt confident starting conversations about financial barriers. After the training, the percentage for both rose to 99%. This matters because routine conversations about sensitive matters can help teams to identify problems early, and connect families with appropriate support.

Improving access to hybrid closed loop (HCL) technology

Another important aspect of the NPDA’s work is to support efforts to reduce inequalities in diabetes care.  This has involved working with organisations who are trying to improve access to hybrid closed loop (HCL) systems and reducing cost as a barrier for families. HCL technology combines a continuous glucose monitor with an insulin pump, adjusting the delivery of insulin automatically. Although users still need to manage some aspects of their care, the technology can minimise burden and the risk of medical emergencies. As such, it can reduce some of the demands placed on children and their families, supporting better sleep and relieving anxiety associated with day-to-day diabetes management.

Uptake of this life-changing technology has almost doubled in two years”

The NPDA has been working with NHS England (NHSE) for several years, introducing changes to its processes to support regular reporting on, access to, and adoption of HCL technology. The audit monitors the uptake of this technology, supplying the data to NHS England, who then reimburses Integrated Care Boards (ICBs) for a significant part of the cost of HCLs across their area. This encourages widespread use, and supports both a 2023 NICE recommendation and an NHS five-year implementation strategy. Before HCL became more widely available through the NHS, some families paid for the technology themselves. The estimated cost of this is currently £2-3,000 up front, followed by £1,500 each year for equipment. A such, self-funding was not possible for many families, and resulted in significant inequities in care. By taking on the role of reporting HCL uptake to NHS England, the NPDA also reduces the burden of doing this on clinical teams, and avoids the need for the same information to be entered into multiple systems.

NPDA data has demonstrated a substantial increase in the use of HCL technology among children and young people in England. In March 2024, uptake was down at 38% but, by March 2025, it had increased to over 64%. Provisional data for March 2026 indicates uptake at over 75%. In other words, uptake of this life-changing technology has almost doubled in two years. Furthermore, all minority ethnic groups and those living in deprived areas increased their uptake, with the gap in access between socioeconomic groups narrowing.

This increase in HCL uptake has coincided with an improvement in median HbA1c, an important measure of average blood glucose over time. The median HbA1c for children and young people in England in March 2024 was 60.5mmol/mol, and this fell to 58mmol/mol by March 2025 (with provisional data for March 2026 showing a further reduction to 56mmol/mol). While the target is <48 mmol/mol, this is a substantial improvement on previous years; since the HCL roll-out, this figure has reduced by 2 mmol/mol per year.

Data as a tool for improvement and equity

Both the Poverty Proofing® and the HCL implementation programmes serve the same underlying purpose: to reduce avoidable inequalities in diabetes care and outcomes. They illustrate the power of clinical audit as a tool for targeted improvement. In addition, while these programmes are focused on paediatric diabetes, much of the learning from them could be applied to other areas of healthcare. After all, issues such as inflexible appointments, limited access to technology and uncertainty about financial support are not unique to diabetes. Routinely considering these issues could help other services to become more accessible, equitable and responsive to the needs of patients. In other words, when evidence from national programmes like the NPDA is used alongside the collective expertise of the healthcare sector, we are able to identify people at greatest risk of unequal care, understand the barriers they face, and ultimately save and improve patients’ lives. Or, as one Poverty Proofing Coordinator stated, when reflecting on the value of this work on a national scale: It is “a valuable opportunity to take this work further and see its impact on a much larger scale.”

Dr Dita Aswani, NHS England GIRFT Clinical Advisor for Children and Young Adult’s Diabetes, explains more about the value of the national paediatric diabetes audit in tackling inequities in healthcare: “In an era of widening health inequalities, the NPDA is far more than an audit. Its greatest strength is not that it measures average performance, but that it reveals who is missing out. Through its unparalleled completeness and granularity, the NPDA enables services, systems and national programmes to identify inequalities that might otherwise remain hidden, whether in care processes, access to technology or health outcomes. The data drives improvement from individual clinics to national policy. Most importantly, the NPDA has helped shift thinking from accepting variation as inevitable, to understanding its root causes and taking action. In other words, using evidence to ensure that every child receives high-quality diabetes care, regardless of their background or where they live.” 

NPDA Workforce Spotlight report

The NPDA has released its latest report, which sought to understand how the structure and delivery of care in paediatric diabetes services, including staffing provision, has changed over time and the relationship this has with diabetes care and outcomes.

Read in full: NPDA Workforce Spotlight report

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