Endocrine Abstracts (2014) 36 P33 | DOI: 10.1530/endoabs.36.P33

Improving the clinical pathway for diabetic retinal screening in paediatric diabetes

Sumana Chatterjee1, Bethannie McIntyre1, Abosede Cole2 & Christine Burren1

1Bristol Royal Hospital For Children, University Hospital Bristol NHS Foundation Trust, Bristol, UK; 2Bristol Eye Hospital, University Hospital Bristol NHS Foundation Trust, Bristol, UK.

Background: Diabetic retinopathy is a frequent cause of vision loss in young adults. NICE guidelines require services to offer annual retinal screening to all diabetic children aged ≥12 years. A local 2009–2010 audit identified 57% underwent screening but only 16% had results documented with the paediatric diabetes service, both areas requiring improvement. In 2011, the paediatric diabetes service formulated a standard operating procedure with the eye-screening programme to improve referrals, screening, and data collection.

Methods: Retrospective analysis of paediatric diabetes patients aged ≥12years, attending a large paediatric diabetes service April 2012–April 2013. Data (obtained from diabetes database, eye screening database, and GP) included: evidence of referral, screening attendance, screening results, results reaching paediatric diabetes database, age diagnosed, duration of diabetes, and HbA1c. Statistical analysis used Fisher’s exact test and independent two-tailed t-test.

Results: From 479 patients, 282 were aged ≥12years. 14 transitioned prior to their annual eye review date. Out of eligible 268, evidence of referral was available for 259 and nine had no data. 241 (90%) had results recorded for submission to National Paediatric Diabetes Audit (NPDA). Remaining 18 received screening but paediatric services had no data recorded. 256 attended screening and three patients did not attend, i.e. screening rate 96% (256/268). Of 251 with gradable images, 18 patients (7.2%) had retinopathy. Those with retinopathy had higher HbA1c (85 mmol/mol) than those without (73 mmol/mol) P=0.011. No correlation was found with age of diagnosis or duration of diabetes.

Conclusion: Increased prevalence of retinopathy in those with worse glycaemic control was confirmed. Screening programmes to improve overall outcomes need to include effective communication. The structured clinical pathway improved screening rates from 57 to 96% and recording rates from 16 to 90%, compared to national recorded 37% screening rate (NPDA 2011–2012), clearly demonstrating effective collaboration between eye screening and paediatric diabetes services.

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