Background: To assess whether the improved service provision introduced under the new Paediatric Diabetes Best Practice Tariff, which includes increased contact with the multi-disciplinary team and greater access to psychology support, has impacted positively on the quality of life (QoL) and glycaemic control of young people with diabetes.
Method: In 2011, n=55 children and young people with diabetes completed the Generic Paediatric Quality of Life Inventory (PedsQL) and the PedsQL Diabetes Module at a single paediatric diabetes centre. Following the introduction of an enhanced service under the Best Practice Tariff in 2012, n=77 children and young people completed the same questionnaires in 2015, as part of their standard annual wellbeing review. The two cohorts were comparable in terms of gender and age. Diabetes treatment details and corresponding HbA1c at the time of psychology reassessment were also collected.
Results: The 2015 cohort included n=74 with type 1 (T1DM) and n=4 with type 2 diabetes (T2DM) at median (range): age of diabetes diagnosis 8.0(1.217.5) years, age of psychology assessment 15.1(7.719.3) years and HbA1c 74(38130) mmol/mol. QoL scores relating to diabetes management and treatment adherence were significantly higher in the 2015 cohort compared with the 2011 cohort at mean(S.D.): treatment Barriers score (77.4(18.4) vs 68.9(19.0), P=0.012); Treatment Adherence score (83.1(14.3) vs 77.6(15.5), P=0.036). Further analyses performed on the 2015 cohort, revealed that older children (r=−0.24, P=0.036), girls (mean(SD): girls 73.7(13.6) vs boys 81.7(11.2), P=0.007) and patients with T2DM (57(3.5) vs 78.8(12.4), P=0.003) had lower Generic PedQL scores. HbA1c was significantly associated with age (r=0.26, P=0.025) and with lower QoL relating to diabetes symptoms (r=−0.24, P=0.034). Regression analysis showed that age was the strongest predictor of poor glycaemic control correcting for age, gender and diabetes treatment.
Conclusion: Increased provision of support following the introduction of the Best Practice Tariff in 2012, was associated with an improvement in the self-reported QoL of children and young people in relation to the management of their condition. However, patients who were female, older and with T2DM were at greater risk of poor QoL. The finding that poorer glycaemic control was related to specific areas of QoL should be explored further.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes