Aim: To audit the current practice of investigations for children presenting with type I diabetes in our centre and identify delays in referral to secondary care.
Standards: Guidelines published by ACDC: Care of the well child newly diagnosed with type I diabetes, NICE: Diabetes (Type I and Type 2) in children and young people August 2015 and local trust guidance Paediatric diabetes - management of newly diagnosed well child.
Methods: In total of 2 year retrospective audit from 20132015. Data collected from trust pathology results, discharge summaries and diabetes database.
Results: In total of 53 cases were audited. 28% of patients presented in diabetic ketoacidosis. Within the cohort 6 patients (11%) had evidence of delay in diagnosis or referral to secondary care identified by primary care requesting laboratory investigations for diabetes or previous presentations to primary care with symptoms of diabetes.
In total of 92% of patients had a laboratory glucose measured at diagnosis with 8% of patients being diagnosed with diabetes on bedside blood glucose testing only. Just 70% had HBA1c sent at diagnosis with no EDTA sample received by the laboratory being the commonest reason for non-compliance with the standard. 85% of patients had anti-IgA tissue transglutaminase measured at diagnosis of diabetes and 2 patients in our cohort were diagnosed with coeliac disease following a positive screening test. 81% of patients had a complete thyroid screen at diagnosis of diabetes (TPO, T4 and TSH) with 4 patients identified as antibody positive but biochemically euthyroid.
Antibody testing for type I diabetes was conducted in 85% of our patients at diagnosis. Of these only 53% had both islet cell (or anti-IA2) and anti-GAD antibodies measured. In line with our local guidance and the new NICE guidance C-peptide was not measured in 90% of our cohort.
Conclusions: No patient had complete investigations for Type I diabetes at diagnosis. To combat this we have developed a new diagnosis of diabetes investigation pack aimed at preventing incorrect blood bottles and insufficient samples being sent. Audit results and referral guidelines for children with suspected Type I diabetes have been disseminated to primary care via the CCG with the aim of preventing future delays.
23 - 25 Nov 2016
British Society for Paediatric Endocrinology and Diabetes