Background: NICE recommendation is to use multiple daily insulin injections and to offer level 3 carbohydrate-counting education at diagnosis of Type 1 diabetes (T1DM), and at least at annual intervals thereafter. Best Practice Tariff states that every young person with diabetes should be offered at least one additional appointment per year with a paediatric dietitian with training in diabetes. Our aim was to identify details of all the patients in the current cohort who were not carbohydrate counting, explore the reasons for this and provide additional support to struggling families.
Method: Data was collected on all T1DM patients at Nottingham Childrens Hospital (352) using Diamond, the diabetes database. Those without a documented carbohydrate ratio were selected and information on: age, sex, current insulin regime, date of diagnosis, Hba1c, admissions to hospital and time since last input from dietician was gathered. Each patient was categorised according to why they were not carbohydrate counting: newly diagnosed, long term non-compliant, taught but struggling with implementation, developing their ability, stable on fixed rate.
Results: patients (6%) were not carbohydrate counting; 57% were boys, 28% > 16 years, 28% <10 years. Average Hba1c 64 (SD 1.689) significantly higher than the clinic overall at 60.9 (SD 16.2). 62% had been seen by a dietician in the last year. All patients were on MDI (multiple daily injections). Three patients were newly diagnosed. 4 patients long term non-compliant. 5 patients had been taught carbohydrate counting but struggling with implementation. 1 patient was developing their abilities. 3 patients stable on fixed rate insulin and the other 4 patients were a combination of these reasons.
Conclusions: Even though only a small percentage of our T1DM patients do not carbohydrate count, the reasons for this need to identified clearly and additional support offered to patients and carers especially in the context of undiagnosed learning disability. While an insulin carbohydrate ratio is documented regularly for each patient who does carbohydrate count, the level of carbohydrate counting (level 1/2/3) or if the ratio is being used effectively, is not routinely documented which needs to improve.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes