Endocrine Abstracts (2016) 45 PA42 | DOI: 10.1530/endoabs.45.P42A

An audit on the outcomes of care in paediatric diabetes

Grainne Curran & Noina Abid

Royal Belfast Hospital for Sick Children, Belfast, UK.

Introduction: NICE CG15 (2004) states that children with diabetes should receive care to achieve optimum control to reduce risk from diabetes complications. The National Paediatric Diabetes Audit (NPDA) aims to improve outcomes in paediatric diabetes. The following describes the outcomes of care in our Paediatric Diabetes Unit (PDU) in comparison to the NPDA (2013-14).

Audit Methodology: Patients aged 1–17 years with a diagnosis of diabetes for ≥1 year on 01/01/15 to 31/12/15 inclusively, were identified using the TWINKLE database. Patients with non-type one diabetes were excluded. Patients were divided into two age groups (<12 years and ≥12 years). Data was extracted on HbA1c, Body Mass Index (BMI), coeliac disease and thyroid function in both groups. Data on Blood Pressure (BP), Albumin Creatinine Ratio (ACR), cholesterol and smoking status was obtained in those aged ≥12 years only. Retinopathy screening (≥12 years of age) was directly obtained from the regional diabetic retinopathy service. Data was compared to the NPDA (2013–2014).

Outcomes: A total of 226 patients were identified (30 excluded due to non-type one diabetes). HbA1c was performed in 100% of patients (98.3% NPDA) irrespective of age. Mean HbA1c was 67.9 mmol/mol (NPDA 72 mmol/mol). About 63% had an HbA1c between 58–80 mmol/mol (NPDA 58.6%). Mean HbA1c increased with increased duration of diabetes. About 67% used ≥4 insulin injections per day (NPDA 54.8%). BMI was performed in 100% (NPDA 94%) with most children having a healthy BMI irrespective of age. Thyroid function testing occurred in 97% (NPDA 36.4%). Thyroid dysfunction present in 3% (NPDA 2.3%). Coeliac disease screening occurred in 95% (NPDA 47.6%) with a prevalence of 8% (NPDA 6.9%). About 52% (n=101) were ≥12 years of age. Of these, 93% had BP performed (NPDA 80.2%) with 8% being hypertensive (NPDA 27.5%). About 54% (NPDA 51.9%) had a formal retinopathy screen. ACR occurred in 85% of cases (NPDA 48.8%) with microalbuminuria evident in 16% (NPDA 7.1%). Serum cholesterol was performed in 97% (NPDA 54.2%). About 76% had a total cholesterol ≤5 mmol/l (NPDA 83.9%). About 1% admitted current smoking (NPDA 2.8%).

Change Practice: A proforma for annual assessment has been devised and will be implemented for recording of outcomes to be as standard.

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