Background: NICE guidelines (NG18) state that paediatric patients aged <18 years old with suspected diabetes mellitus (DM) should be immediately referred to specialist care to confirm diagnosis and provide immediate treatment. The Nottingham University Hospitals (NUH) Paediatric Endocrine team advise primary care to investigate suspected hyperglycaemia using a POCT (point of care testing) glucose meter at the primary care facility to avoid the delay incurred by sending a sample to the laboratory. The aim of this study was to ascertain compliance with this advice and identify any cases where there was a potential delay in diagnosis.
Methods: Retrospective analysis (April 2018April 2019) identified 1641 laboratory random glucose requests for patients <18 years of age in the Nottinghamshire area. A >7.8 mmol/l cut-off was used to identify patients who should have been referred immediately to secondary care for confirmation and treatment.
Results: The results (n=1641) identified 16 patients with glucose results >7.8 mmol/l, of which 5 had results >11.1 mmol/l; consistent with a diagnosis of DM (Type-1 DM: n=4, Type-2 DM: n=1). Five patients had confirmed delayed referrals, of which 2 patients presented in diabetic ketoacidosis (DKA). Of the remaining 11 patients (>7.8 ≤11.1 mmol/l), 1 was a new diagnosis of Type 2 DM, 1 was a known case of DM and 9 patients were non-DM related or unknown requests. No hypoglycaemic (<2.6 mmol/l) patients were identified. 392 (23.88%) requests had DM specific symptoms (polyuria, polydipsia, tiredness, weight loss); 883 (53.80%) requests were non-DM related (routine screen, monitoring, abdominal pain, dizziness).
Conclusions: Primary care paediatric glucose requests showed lack of conformity to the recommended diagnostic pathway. 392 blood glucose requests were sent despite DM being considered as a differential which should have prompted a POCT glucose check. This increases risk of delayed diagnosis and management in children with undiagnosed Type 1 DM. Communication and training between NUH and primary care continues to be essential to improve standards of care but can be challenging to arrange with all CCGs across the region. In addition, an alert is now being set-up for electronic requests of glucose for primary care, encouraging the use of POCT glucose.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes