Objectives: To assess current clinical practice in children aged 05.99 years with Type I Diabetes Mellitus (T1DM).
Methods: All paediatric diabetes centres (n=17) within a single UK region were asked to provide retrospective data for the year ending 01/12/07. 15 (88%) centres responded and provided data for each child on presentation, initial and current insulin regimens. Outcome measures were HbA1c, and acute hospital admissions post-diagnosis for diabetic ketoacidosis (DKA) and hypoglycaemia. Paediatric Diabetes Nurse Specialists at each centre completed questionnaires on care provision and current clinical practice.
Results: T1DM children aged 05.99 years comprised 6.6% (n=170) of all children under Paediatric Diabetes care in this region. Forty-four percent of T1DM children aged 05.99 years initially presented in DKA. About 4.8% (n=8) of children had no HbA1c recorded, but only one of these had diabetes for more than 6 months. Average HbA1c was 8.7% (with a range of 7.89.5% across centres). Of the children who had an HbA1c recorded, 16% (n=26) had an HbA1c of ≤7.5%, but 6.8% (n=11) had an HbA1c of ≤7.5% in those with T1DM for >12 months duration. Within the 113 children with T1DM aged 0 to 5.99 years and duration of diabetes longer than 12 months, younger age was associated with higher HbA1c (P=0.01). Insulin regimens differed significantly between centres (P=0.02). About 10% were on continuous subcutaneous insulin infusion therapy (CSII); these came from only 43% of the centres and they resided in less deprived areas compared with those on subcutaneous therapy. Children on CSII therapy for >1 year had a higher rate of DKA admissions during the previous year (P=0.02). 86% of Paediatric Diabetes Nurse Specialists considered that their current service provision was insufficient to meet clinical needs.
Conclusions: While the region is performing well in many aspects of care, there are significant differences between centres in terms of patients, diabetes management, and outcomes. This is being addressed by the development of a Regional Diabetes Network. Further studies should confirm whether in young children with T1DM, treatment with CSII is associated with an increased risk of DKA.
05 - 07 Nov 2008
British Society for Paediatric Endocrinology and Diabetes