Background: NICE guideline NG18 recommends that all children aged >12 years should receive seven key care processes in order to obtain optimum glycaemic control and reduce the risk of long-term complications, which is assessed in the NPDA. In order to assess our patient population we have looked at the seven key care processes and compared to NPDA 2015/2016.
Method: We collected data retrospectively on all children aged >12 years18 years and diagnosed > 1 year with Type 1 Diabetes at annual review between January and December 2016, using TWINKLE data base, Electronic care record, Labcentre and the NI retinopathy screening service. Data was collected on the seven key care processes including annual review completion in excel.
Results: One hundred and eight patients were identified, and of these 99 patients (91.7%) had annual reviews completed. (patients missed annual review: three missed due to poor attendance, one patients Mum checked their bloods outside of clinic, one awaited transition, two patients annual reviews were just outside of 1 year period, and two patients moved to insulin pumps during year 2016. This was an improvement on previous years data with 90% annual reviews completed, 45.5% had all completed all seven key processes compared to 57% on the previous year. In comparison to NPDA 2015/2016 data, we had a higher completion rate compared to 35.5% completed. When comparing the seven key care processes individually to the NPDA 2015/2016 data, we had higher completion rates on all key care processes except BMI. (96% compared to 97.9%). HbA1C 100% compared to 99.3%, BP 91% compared to 90.8%, urinary ACR 86% compared to 60.8%, retinopathy screening 71.7% compared to 66.2%, foot examination 73% compared to 65.8% and TFTs 95% compared to 77.7%. However, there was a decline noted in data recorded compared to our previous year of 2015, notably BMI, BP, TFTs and foot examination. Mean HbA1C was just above NPDA at 68.73 mmol/mol compared to 68.3 mmol/mol.
Conclusion/Recommendation: An annual review proforma was proposed after last years annual audit 2015 but was not used in practice, subsequently not improving completion rates. Therefore, an annual review checklist for each clinic room has been proposed to improve completion rates.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes