Introduction: An HbA1c target level of 48 mmol/mol or lower in children with type 1 diabetes is recommended by the National Institute for Health and Care Excellence. Only 7.1% (national average 7.2%) of children in our unit achieved this target. In response, during a multidisciplinary diabetes away day, we explored innovative approaches to timely and efficient identification and intervention in patients with high HbA1c levels. The National Paediatric Diabetes Audit web portal, at present, does not allow a prospective dashboard function at a unit or individual patient level.
Methods: We developed a free and user-friendly spreadsheet to record and analyse HbA1c levels prospectively for every patient. Sort and chart functionalities were used to make the data relevant for the unit and individual patients and parents.
Results: Our bespoke database serves as a visual HbA1c dashboard, where prospectively inputted HbA1C levels are automatically RAG rated, to effectively flag patients with poor control. This database is utilised at fortnightly multidisciplinary diabetes meetings to quickly identify and discuss patients (23 children at each meeting) with highest or worsening HbA1c levels and those who have missed their quarterly measurements. Moreover, each patient is able to see their HbA1c temporal trend in clinic, as a bar chart, facilitating engagement. Ongoing work in the second stage of this QI project include analysis of factors associated with poor HbA1c control. We aim to devise patient-specific input from the multidisciplinary team to empower patients and parents.
Conclusions: We are keen to share how we have creatively utilised a simple and already-available software on Trust computers to develop a patient-centred tool to improve clinical outcomes and patient and parent engagement. We believe that this can be replicated in other units.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes