Abstract
Māori and Pacific Peoples (indigenous to New Zealand and the Pacific Islands, respectively) with type 1 diabetes (T1D) are underserved in terms of both glycaemic outcomes and access to advanced diabetes technology. A cohort study (n = 1303) by Chepulis et al. found that Māori had a median HbA1c 14 mmol/mol higher than non-Māori and were significantly less likely to use insulin pump technology. Furthermore, Wheeler et al. found that Māori and Pacific peoples faced disparities in access to insulin pumps irrespective of socioeconomic status. Equitable access to advanced diabetes technology is an area of utmost importance. Accordingly, this trial aims to evaluate the glycaemic outcomes and safety of automated insulin delivery (AID) in ethnically minoritised groups.
In this prospective, multicentre, single arm trial, AID-naïve Māori and Pacific adults (aged 16 – 65 years inclusive) with T1D and elevated glycaemia (HbA1c ≥ 64 mmol/mol [8.0%]) used the MiniMed™ 780G AID system for 13 weeks. Primary outcome was the change in HbA1c from baseline to 13 weeks. Secondary outcomes included standard continuous glucose monitor metrics, psychosocial outcomes assessing diabetes treatment and impact on life, and safety. Twenty participants were enrolled and 19 completed the trial. HbA1c decreased from 85 ± 18 mmol/mol (10.0 ± 1.6 %) at baseline to 56 ± 7 mmol/mol (10 ± 1.6 %) at 13 weeks. Time in range (3.9-10 mmol/L [70-180 mg/dL]) increased from 27.6 ± 13.3 % at baseline to 64.5 ± 13.2 % after 13 weeks. After 3 months, participants reported improvements in diabetes treatment satisfaction and diabetes impact. No episodes of severe hypoglycaemia or diabetic ketoacidosis occurred.
In this trial of 19 Māori and Pacific adults with T1D and above-target glycaemia, AID led to significant improvements in glycaemic outcomes. These results highlight the potential of AID in reducing ethnic inequities in diabetes care.