Introduction: Current NICE guidelines recommend that children and young people with Type 1 Diabetes Mellitus (T1DM) should aim for a target HbA1c ≤48 mmol/mol (6.5%) to reduce the risk of long-term complications. The National Paediatric Diabetes Audit (NPDA) shows that the number of young people under the paediatric diabetes service with HbA1c >75 mmol/mol at this District General Hospital has been consistently and significantly above both the North West and national average. This has serious future health implications for our patients and creates a persistent pressure on the service.
Aims: To assess the degree to which the recommendations from the previous audit (2017/18) have been implemented into current practice. To identify barriers to better glycaemic control and suggest recommendations for the diabetes service to put into practice to improve the management of patients with consistently high HbA1c.
Methods: All paediatric patients with two or more previous consecutive HbA1c >75 mmol/mol were identified from NEXUS. A number of patients parameters including age, sex, number of clinic visits and insulin regimen were analysed to assess for correlation with increasing HbA1c. All data collected was from the period 23 April 2018 to 23 April 2019.
Results: 47 patients were identified as having their latest HbA1c >75 mmol/mol; 7 patients were excluded based on an isolated result. 22 females (54%) and 18 males (46%) were identified. 21/40 (52.5%) patients were in the 1618 age-group compared to 40% and 43% in 2016/17 and 2017/18 respectively. All patients with HbA1c >130 mmol/mol were age 1518 years. The proportion of children on multiple daily injections and continuous subcutaneous insulin infusion regimens was equivalent to the national average. All diabetes-related hospital admissions occurred in patients with HbA1c ≥100 mmol/mol. 9 patients had documented evidence of receiving alcohol and 25/40 patient were offered dietetic input.
Conclusions: The transition period (1618 age group) appears to be a focus for deteriorating disease control. Higher HbA1c measurements observed in this group were associated with diabetes-related hospital admissions indicating the need for more extensive input. Documentation of dietetic input and alcohol education remains poor.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes