Background: Children with HbA1cs in target within the first year of diagnosis of diabetes show tracking of future results1 and experience fewer long term complications.2 This phenomenon is called metabolic memory.3 HbA1C depends on a combination of patient factors and quality of care offered by the team (intensive insulin, communication, and support). We hypothesized that well managed, supported, patients should achieve target HbA1cs at least once during the first year (when they are often in partial remission). Currently the National Diabetes Audit excludes HbA1c data during this time.
Aims: i) To compare number of children achieving ≥1 HbA1C <58 mmol/mol in the first year of diagnosis across Eastern England and ii) attempt to set an audit standard, to improve long-term health.
Methods: Data was collected for HBA1C values (at diagnosis and 3 monthly for 1 year), hypoglycaemia requiring hospital attendance, and basic demographic details for patients diagnosed with T1DM between 1/9/2011 and 31/8/2012
Results: 6/17 units in the region participated in this survey (n=98). 6/98 patients were excluded because they moved. Overall 69% of patients achieved ≥1 HBA1C <58 mmol/mol. Results for individual hospitals were 30, 56, 69, 78, 80, and 81%. Less than 2% of patients had hypoglycaemic episodes.
Discussion: It is possible to achieve at least 1 HbA1c <58 mmol/mol in the first year of diagnosis without causing severe hypoglycemia in the majority of patients. The hospital with worse outcomes was experiencing staffing difficulties. We propose that units should aim to achieve HBA1C <58 mmol/mol at least once in the first year of diagnosis in greater than or equal to two out of three of patients to provide a good start to long term control. This could be used as a standard of assessing quality of care provided. Underperforming units can learn from practices of better performing units.
References: 1. Wright A. Review: Metabolic memory in type 1 diabetes. British Journal of Diabetes & Vascular Disease 2009 9 254.
2. Edge J et al. Persistent individual tracking within overall improvement in HbA1c in a UK paediatric diabetes clinic over 15 years. Diabetic Medicine 2010 27 12841288.
3. Jax T. Metabolic memory: a vascular perspective. Cardiovascular Diabetology 2010 9 51 (doi:10.1186/1475-2840-9-51).
12 - 14 Nov 2014
British Society for Paediatric Endocrinology and Diabetes