Interest in Hybrid Closed Loop is High Across the Socioeconomic Spectrum Despite Current Inequalities in Provision in a Large UK Diabetes Centre.

The rapidly evolving field of closed loop technology promises to revolutionise the management of type 1 diabetes.1 Several systems are now commercially available in the United Kingdom and are supported by a robust evidence base.2,3 Currently only 3.8% (190/4952) of adults with type 1 diabetes within our health board (NHS Lothian) are on hybrid closed loop (HCL) systems. Of current HCL users, only 6.3% belong to the most deprived Scottish Index of Multiple Deprivation (SIMD) quintile whilst 37.4% belong to the most affluent quintile. 70% of HCL users are female (explained, in part, by use commenced in pregnancy). To help gauge interest in diabetes technologies (and HCL in particular), we sent a questionnaire to all 2210 people with type 1 diabetes attending Royal Infirmary of Edinburgh clinics (the largest diabetes clinic within NHS Lothian). As the primary purpose of this exercise was service planning and delivery, ethical approval was not required. There were 782 respondents (35.4% response rate). Responders were older (51 years [36– 63] vs. 43 [29– 58], p < 0.001), had lower HbA1c (60 mmol/mol [52– 69] vs. 66 [57– 79], p < 0.001), were more likely to be CSII users (30.5% vs. 16.3%, p < 0.001) and were more affluent (SIMD 5 response 43.5% vs. SIMD 1 response 24.9%, p < 0.001). Of those not currently using continuous subcutaneous insulin infusion (CSII), 48.2% (274/568) expressed an interest in using this technology. Of those not currently using HCL, 66.5% (485/729) expressed an interest in HCL use. Lower age was strongly associated with interest in HCL (47 years [33– 59] vs. 58 [46– 68], p < 0.001). Current CSII users and Freestyle Libre users were significantly more likely to express an interest in using HCL as were those with positive anxiety (GAD2) and depression (PHQ2) scores (Table 1). The only significant difference in CGM