Endocrine Abstracts

Background: The National Paediatric Diabetes audit (NPDA) reports increasing number of children and young people with type 2 diabetes (CYP2D). CYP2D are less likely to receive all recommended health checks compared to those with type 1 diabetes (33% vs 59% respectively) and do not receive treatment for complications even when they are identified (T2D spotlight audit 2019/20). We assessed variation in care across different units against the national T2D guidelines.

Methods: A questionnaire concerning the management of CYP2D was distributed between December 2022- February 2023 to Paediatric Diabetes units across the UK.

Results: 109 units (17, tertiary) responded, encompassing 824 patients. The majority of CYP2D were managed at District General Hospitals (DGHs) (n=603). The majority of units (75%) managed fewer than ten patients with T2D. Dedicated T2D clinics were reported by 13% (n=12/92) DGHs and 41% (n=7/17) tertiary centres. Blood pressure (BP) at each clinic visit was undertaken by 83% of units and rest measured it annually. The majority (73%) of units were able to initiate ambulatory BP monitoring when indicated. Following diagnosis of hypertension, 15% initiate treatment independently whereas 62% did so under specialist guidance; and 37% referred to a specialist. Tertiary centres were more likely to have a referral pathway for hypertension than DGHs (88% vs 16%, respectively). Obstructive sleep apnoea (OSA) screening was undertaken by 17% at diagnosis, 23% annually, 18% at each clinic visit and 42% occasionally. OSA pathway was available in 54% of units. Dyslipidaemia screening at diagnosis was undertaken by 93.6% and guidelines on treatment was available in 38%. Non-alcoholic fatty liver disease (NAFLD) screening was undertaken by 91% of centres(54% used liver function tests (LFTs) and 43% used both LFTs and liver ultrasound scan).

Conclusion: The majority of CYP2D are managed at DGHs with very few centres having dedicated T2DM clinics. Screening and management for hypertension, dyslipidaemia and NAFLD has improved since the spotlight audit. Tertiary centres were more likely to have referral pathways for identified co-morbidities. Improving outcomes for CYP2D is one of the NHSE care priorities and the findings of the survey identifies key areas of improvement for future work.