Introduction: Most children & young people (CYP) with symptoms of type 1 diabetes (T1D) tend to present to primary care. Delayed diagnosis is common and is associated with a risk of developing diabetic ketoacidosis (DKA). The prevalence of DKA at diagnosis over the last 20 years remains unchanged despite current NICE guidance and Diabetes Delivery Plans which promote prompt diagnosis of T1D. The aim of this QI initiative was to develop effective pathways to facilitate early diagnosis of T1D with the primary long-term objective of reducing the DKA incidence at diagnosis.
Methods: Key partners in primary and secondary care identified barriers faced by healthcare professionals and developed QI initiatives to improve timely diagnosis. This included a simple referral pathway, feedback tools and sustained GP training in early recognition of diabetes. Two annual audit cycles using retrospective case note analysis of all newly diagnosed CYP in Cardiff were completed. The first cycle (2017) represented pre-change with the second cycle after adopting QI changes in 2018. Key outcomes included blood glucose (BG) testing and prompt referral.
Results: Pre change: 22 CYP were newly diagnosed with T1D,19/22 presented to primary care; of the 19, 4 were in DKA, 10 had point of care(POC) BG testing and 2 had urine tests prior to referral. 3 had had fasting BG resulting in delayed referral. 3 of the 4 in DKA had delayed diagnosis. Post QI initiatives: 32 were newly diagnosed, 22/32 presented to primary care; of the 22, 6 were in DKA,17 had POC BG test, and 3 had urine tests. Of the 6 in DKA, 5 were at first presentation to primary care, had POC testing and were promptly referred. Post QI initiatives, 91% had POC testing and prompt referral to secondary care, contrasted with 63% pre change.
Conclusion: Although there was no reduction in overall DKA rates at diagnosis of T1D, we have demonstrated a clear improvement in prompt diagnosis following QI initiatives between primary and secondary care. This QI programme is now being tested across other parts of Wales with a long-term plan to promote early diagnosis and reduce the incidence of DKA.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes