Objectives: In April 2013 a new payment tariff was introduced to enable better funding and comprehensive provision of paediatric diabetes care. We aimed to assess if this new tariff and increased resources have improved glycaemic control in children with diabetes.
Methods: This was a retrospective analysis of HbA1c, insulin requirements and BMI in all patients under the care of the paediatric diabetes team at a district general hospital for at least 1 year prior to and following the introduction of the tariff.
Results: A total of 148 patients were included, 73 (49.3%) were male. Median age at diagnosis was 7 years (IQR 410) and median duration of diabetes was 3 years (IQR 15). All but 2 patients had type 1 diabetes mellitus. 58 (39.2%) were on a basal bolus regimen, 41 (27.7%) on a continuous subcutaneous insulin infusion (pump) and 48 (32.4%) used multiple methods of insulin delivery during the study period.
The median BMI before tariff introduction was 19.3 kg/m2 (IQR 17.322.1), rising to 21.0 kg/m2 (IQR 18.223.3) after introduction. Median HbA1c was 73.3 mmol/mol (IQR 6783) prior to and 75 mmol/mol (IQR 6690) following the tariff introduction (p=0.002). Median increase in HbA1c was 2.5 mmol/mol (IQR −3, 10).
There was no difference in HbA1c by sex, age group or duration of diabetes, and no relationship with initial glycaemic control. No difference was found in HbA1c according to method of insulin delivery. However, patients who started pump therapy after tariff introduction had an improved HbA1c compared to patients already using a pump.
Conclusions: We found a marginal worsening of glycaemic control following introduction of the paediatric diabetes tariff. This a rise in HbA1c could be due to increased duration of diabetes, but also could reflect the response of patients to a change in service structure. The improved HbA1c in subgroup of patients started on pump therapy since tariff introduction suggests better patient selection with new pathway and increased resources. Further work should focus on assessing the HbA1c trend in newly diagnosed patients pre-tariff, compared with patients diagnosed since, to determine whether this rise in HbA1c is really related to the service being offered.
23 - 25 Nov 2016
British Society for Paediatric Endocrinology and Diabetes