Introduction: YDC is a partnership of four hospital trusts;Kings College Hospital, Princess Royal University Hospital, Lewisham University Hospital and Evelina London Childrens Hospital,caring for a total of 492 children and young people with diabetes. Most young people are on conventional long acting insulin (Levemir and Glargine), but increasingly, poorly controlled patients (HbA1C>100 mmol/mol) with high admission rates are being switched to insulin Degludec due to prolonged duration of action and improved injection experience.
Objective: To assess the impact of conversion to Degludec on HbA1C, A&E and inpatient admissions with Diabetic Ketoacidosis (DKA), and clinic absences in young people with diabetes.
Methods and design: A retrospective observational study was done across four sites from October 2014 to April 2017 on the advice of the joint formulary committee who approved Degludec for paediatric use. Data was collected from case notes and clinic letters. Demographic variables, monthly data on A&E attendances, DKA admissions, and Clinic DNAs (Did Not Attend)/rescheduling in the year pre-and post-starting Degludec and HbA1C at 3,6 and 12 months were collected.
Results: Forty-eight patients (46-Type1,2-Type 2, M:F-25:23, mean age 15.3years (range 1119) with poor control (mean HbA1C 105 mmol/mol) were included. Follow up on Degludec ranged from under 3 months to 2years. There was a statistically significant drop in monthly inpatient admissions with DKA (n=48, mean 0.06 pre and 0.03 post Degludec, P=0.027) after Degludec was started. There was a marginal decrease in monthly A&E admissions which was statistically non-significant.Mean HbA1C dropped from the start (n=48, mean 105 mmol/mol) to 3 months (n=25 mean 104.58 mmol/mol) and 1 year (n=15 mean 101 mmol/mol) after starting Degludec,with a mean of 107 mmol/mol (n=32) at 6 months.This was statistically not significant. There was no drop in monthly clinic DNAs.
Conclusions: The results show a significant drop in DKA admissions and a drop in HbA1C at 3 months and 1 year. It would be important to verify these changes with bigger numbers such as using data from across our South East Coast and London Diabetes Network.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes