Background: Recent NPDA 15/16 data shows that nationally 17.9% of children and young people (CYP) with type 1 diabetes mellitus (T1DM) have a HbA1c level >80 mol/mol (7.9% at Nottingham Childrens Hospital (NCH)), putting them at increased risk of diabetic ketoacidosis and long-term sequelae. To support patients on the high HbA1c pathway (>80 mmol/mol) at NCH, a 5-day inpatient stay for stabilisation is offered. The process involves daily re-education from paediatric diabetes specialist nurses and dietitians. Stabilisation quizzes are offered to identify gaps in knowledge and psychological or social care involvement is offered if necessary. Stabilisation is designed to educate and support patients and carers to improve the self-management of the young persons condition.
Method: This single-centre study utilised retrospective data from medical records on all patients admitted to NCH for stabilisation between April 2014 and June 2017. Information on the age at admission, diabetes duration, pre-admission and post-admission HbA1c, psychological and social care involvement was recorded. The pre- and post-stabilisation HbA1c levels were then compared using Excel.
Results: In total 27 patients (51.8% female) were admitted, mean age at the time of stabilisation was 13.5-years (S.D. ±2.87). Two patients were admitted twice for stabilisation 72% of patients saw a reduction in their HbA1c value, measured at the next clinic appointment after stabilisation, compared with their pre-stabilisation value. The cohorts mean pre-stabilisation HbA1c was 89.5 mmol/mol (S.D. ±25.39) whereas the mean HbA1c value at the next clinic appointment after stabilisation was 80.2 mmol/mol (S.D. ±15.89). 80% of patients saw a reduction in their HbA1c values 6 months post-stabilisation compared to their pre-admission HbA1c, with the mean HbA1c value 6 months post-stabilisation being 78.6 mmol/mol (S.D. ±20.67). 68% of patients saw a reduction in their HbA1c values 12 months post-stabilisation compared to their pre-admission HbA1c, with the mean HbA1c value 12 months post-stabilisation being 83.2 mmol/mol (S.D. ±20.56).
Conclusion: There is no clear evidence about how to best manage CYP with poorly controlled T1DM however, this study shows that stabilisation is effective at reducing HbA1c values, with the greatest decrease occurring six months after the inpatient stay.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes