Background: Children and Young People (C&YP) with poorly controlled diabetes are at increased risk of diabetic ketoacidosis (DKA) and long-term sequelae. There is no clear evidence about how best to manage them. NPDA data highlights that UK numbers are in decline, but still constitutes 21.3% of C&YP with diabetes. The high HbA1c pathway at Nottingham Childrens Hospital (NCH) aims to systematically identify and support C&YP with HbA1c >80 mmol/mol. It provides regular contact, school involvement, psychology input, and intensive re-education, including an inpatient stay and referral for social support if necessary.
Methods: Medical notes of 89 C&YP on the high HbA1c programme at NCH, from March 2012 to September 2015 (42 months) were retrospectively reviewed. Data was analysed using Microsoft Excel.
Results: In total of 89 C&YP (45 female), median age 15-years, were initiated on the pathway. The median pathway duration was 3 months 14 days, with almost half remaining on for less than 3 months. 4 young people being unable to achieve adequate control within the data collection period. About 30 C&YP were on the pathway at any one time, representing <10% of our clinic population.
In total of 42 (47%) had multiple starts on the pathway, with a median age of 16-years. Median HbA1C on initiation was 89 mmol/mol, with subsequent measurement at 6 months being 77 mmol/mol (where available). Of this group, 5 had social care involvement and 3 were identified as having a CAF in place.
In total of 47 (53%) were started on the pathway only once, with a median HbA1C of 85mmol/mol. Within this cohort, subsequent median HbA1C measurement at 6 months was 69mmol/mol (where available). On average, their pathway duration was 1 month less than those who had multiple starts.
In total of 47 (53%) successfully received 2 weekly contacts with the team, 56 (63%) had an MDT within 68 weeks. Carbohydrate counting refreshers were offered in 38 cases and 21 (25%) had psychological input. 21 were admitted for stabilisation.
Conclusion: The high HBA1c pathway was developed to increase support to those struggling with poor control, to highlight concerns and escalate as necessary. NCH has half the number of C&YP with poor control compared to the national average.
23 - 25 Nov 2016
British Society for Paediatric Endocrinology and Diabetes