Addressing inequalities in access and care in type 1 diabetes - The North-East London Type 1 Diabetes Transformation (NATALIE) project
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Mallik, Ritwika
Marples, Owen
Vijayaraghavan, Shanti
Garrett, Christopher
Chowdhury, Tahseen A.
Anderson, John V.
Huda, Mohammed Sb
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2026
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AIMS: The North-East London Type 1 Diabetes Transformation (NATALIE) Project aimed to accurately provide data on place of care for people with type 1 diabetes (T1D) and assess the impact of interventions to engage people with T1D not accessing specialist care or those assigned to a high-risk register. METHODS: Systematic searches were carried out to identify dual coding/no coding for type of diabetes and were followed by practice level case note review by a healthcare professional (HCP). The Clinical Effectiveness Group (CEG), which is a local primary care-led clinical academic group, was commissioned to aid with data searches. In City & Hackney, following the audit, the impact of pilot interventions was evaluated. These included a primary care toolkit, to improve engagement and of focused clinical care for those assigned to a high-risk register (HbA(1c) >75 mmol/mol) were analysed. RESULTS: One hundred and fifty general practitioner (GP) practices engaged and 2499 patient records were reviewed. The proportion of people with T1D receiving care in primary care alone varied from 12.9 % to 37.7 % with a mean of 30 %. Following interventions including secondary care referral, referring for Freestyle Libre monitoring or structured education, the number of people with T1D under primary care alone reduced from 36 % to 24 %. The 85/133 people with T1D on the high-risk register who engaged with focused clinical intervention decreased their HbA(1c) from 93 mmol/mol to 83 mmol/mol. CONCLUSIONS: In an area of high socioeconomic deprivation, the NATALIE project showed that an average of 30 % of people with type 1 diabetes are under primary care alone, and simple interventions improved this by up to 10 %. Furthermore, focused clinical contacts with high-risk people with T1D can reduce HbA(1c) by 10 mmol/mol.
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Primary care diabetes