Endocrine Abstracts (2013) 33 P45 | DOI: 10.1530/endoabs.33.P45

Local factors influencing service improvements in median HbA1c in children and young people with diabetes between 2003 and 2012

Melanie Kershaw1, Ruth E Krone1, Nils Krone2, Wolfgang Hogler1, Nicholas Shaw1, Jeremy Kirk1 & Timothy Barrett2

1Birmingham Children’s Hospital, Birmingham, UK; 2University of Birmingham, Birmingham, UK.

Background: HbA1c is a marker for the risk of long-term complications of Diabetes. Our unit cares for 349 children and young people (CYP) from a population with a higher than average prevalence of low-income families, ethnic minority families, and high unemployment. Over the last 10 years there have been service improvements, increased resources and changes in practice.

Aims: To review HbA1c outcomes achieved annually from 2003, compared with published national paediatric diabetes audit (NPDA) data, and to determine service factors impacting on this.

Methods: Data on HbA1c submitted to the NPDA from January 2003 to December 2012 was extracted from our patient management database to calculate the annual median HbA1c and the percentage of CYP achieving HbA1c<7.5%. Clinical service changes were reviewed and mapped to these outcomes.

Results: Median HbA1c fell from 9.4 to 8.3%, between January 2003 and December 2011, compared with a national fall from 8.9 to 8.7% in the NPDA. We demonstrate a further reduction to 8.1% by December 2012. The proportion of CYP achieving HbA1c less than 7.5% rose steadily from 12% in 2004 to 25% in December 2011, compared with 14.7 to 15.7% in the NPDA. We have achieved a further increase to 29% in 2012.

Discussion: The fall in HbA1c and improvement in proportion of CYP achieving target HbA1c exceeds that observed nationally. The UK remains behind many European counterparts in securing reduced long-term risks. Changes to our clinical service resulting in improvement over this period include increased staff (2003), MDI introduction (2005/6), CSII introduction (2008/9), and increased promotion and recruitment to interventional and non interventional diabetes research studies (2009–2012). Services witnessing improvement in outcomes have a continuing responsibility to share strategies employed, with the aim of improving paediatric diabetes care across the UK.

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