Endocrine Abstracts

Background: Children and young people (CYPwD) with a persistent high HbA1c are at greater risk of developmental and long-term complications. Diabetes services across the England & Wales are mandated to have a ‘high HbA1c’ policy by the Best Practice Tariff quality standards, to improve health outcomes.

Aim: To evaluate the Birmingham Women’s and Children’s (BWC) Diabetes Team ‘High HbA1c Policy’ from 2016 – 2019.

Methods: Data extraction from the Twinkle database. Main outcome measures for the type 1 & 2 diabetes cohort from 2016-19 were; mean HbA1c, percentage of cohort with one or two HbA1c’s above different cut-offs from 64 mmol/mol to 86 mmol/mol, and the change in HbA1c for CYPwD attending and not attending the new high HbA1c clinic model implemented in 2018.

Results & discussion: In 2017 there was a 15 mmol/mol (P < 0.01) lower HbA1c over the year for those CYPWD with a high HbA1c receiving ten or more face to face contacts, the “tipping point”. The “tipping point” was implemented by a new high HbA1c clinic model in 2018, which mandates two, nurse or dietitian appointments between three monthly clinics. The new model resulted in a reduction in overall cohort HbA1c from 67.8 mmol/mol in 2017 to 63.3 mmol/mol in 2018 (P < 0.01), making the BWC Diabetes Team a positive outlier for HbA1c in the NPDA national audit. The success of 2018 was driven by two things. Firstly, the purposeful communication of what is a high HbA1c to all CYPWD. Secondly, the CYPwD who attended their high HbA1c clinic appointments reduced their HbA1c by 10.2 mmol/mol (P < 0.01). Those who did not attend, mainly those with an HbA1c 86 mmol/mol, increased their HbA1c by 12.2 mmol/mol (P < 0.01). The introduction of a clinical administrator in 2019 increased high HbaA1c clinic attendance by 59%, whilst dropping the DNA rate by 50%. This resulted in further HbA1c reductions.

Conclusion: Using purposeful communication to exceed the “tipping point” of annual face to face contact for CYPwD with a high HbA1c appears essential to improve glycaemic control. Dedicated clinical administration staff is vital for clinic efficiency and effectiveness. A new strategy is needed for those with a HbA1c 86 mmol/mol.