Introduction: We were one of ten paediatric diabetes teams taking part in the pilot RCPCH QI project initiated in Autumn 2017 and the sole representative from the North East of England. The project we chose was to enable and empower children, young people and their families to improve overall diabetes management, long term health and wellbeing through education and knowledge in adjusting insulin to improve blood glucose control.
Method: We created a bespoke diabetes empowerment tool giving advanced diabetes education and practical advice of how to make appropriate changes to insulin to improve HbA1c. After making improvements following focus group feedback the tool was given to all patients and families along with individualised education within clinic of how to use it. At the same time we set up a download clinic to encourage downloading of meters and pumps and promote communication with the team via email or telephone. We surveyed all patients before and after the QI project about self-adjustment and we assessed HbA1c from the start of the QI project, September 2017 to March 2019.
Results: Patients self-adjusting pre QI: (55 responses)
1. Never 18.18%
2. 3 monthly 14.55%
3. Monthly 18.18%
4. Weekly 29.09%
5. Daily 20%
Patients self-adjusting June 2019: (29 responses)
1. Never 31%
2. 3 monthly 13.79%
3. Monthly 17.24%
4. Weekly 13.79%
5. Daily 24%
Percentage of patients accessing download clinic June 2019: 60.7% of patients
1. April to September 2017 64 mmol/mol
2. October 2017 to March 2018 63.5 mmol/mol
3. April to September 2018 58.75 mmol/mol
4. October to March 2019 58.75 mmol/mol
Conclusion: Overall the effect of involvement in the QI project has been an extremely positive one. Mean HbA1c had been static for two years until the dramatic reduction following the QI project. Despite positive feedback for the empowerment tool there are a significant number of our patient group who remain uncomfortable self-adjusting insulin and this must remain patient choice. We continue to develop our empowerment tool and are focussing on patients in the first 6 months of diagnosis to embed good practice early.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes