Endocrine Abstracts

Background: Type 2 diabetes in children is an aggressive condition associated with complications including neuropathy, nephropathy, cardiovascular disease, and early mortality. National guidelines, including those from ACDC (endorsed by BSPED), recommend asymptomatic screening in children with a BMI >85th centile plus another risk factor, such as family history or high-risk ethnicity. Failure to identify at-risk children delays timely intervention. A baseline audit in November 2024 showed that only 1 in 10 eligible children were being screened at our District General Hospital. A pre-project survey also revealed limited awareness among paediatric doctors of the current screening criteria.

Aim: To increase the rate of asymptomatic Type 2 diabetes screening in eligible children attending general paediatric outpatient clinics to at least 5 in 10.

Methods: The primary outcome was the proportion of eligible children who had an HbA1c test recorded on Cerner following clinic attendance. Children with haemoglobinopathies or a recent HbA1c result were excluded.Multiple interventions were tested using PDSA cycles. These included:

• Creation and dissemination of an infographic outlining screening criteria (via email, WhatsApp, and posters in clinic rooms)

• Development of a patient information leaflet to support clinician counselling

• A departmental teaching session on screening guidelines

• Individual discussions with consultants to encourage engagement

Results: Screening rates improved from 1 in 10 to nearly 4 in 10 by February 2025. A re-audit four months later confirmed this improvement was sustained. However, no statistically significant shifts were seen on run chart analysis, likely due to variability in clinician decision-making; screening was often omitted when bloods were not otherwise required or when eligibility was borderline.

Conclusion: This project demonstrated that simple, targeted interventions can substantially increase awareness and implementation of Type 2 diabetes screening guidelines in a paediatric outpatient setting. Further strategies may be needed to embed screening into routine practice, particularly for borderline cases or when no other investigations are planned.