Reduction of high HbA1c in children and young people with type 1 diabetes mellitus through implementation of a

Emily Cooper; Charlotte Button; Chun Lim

doi:10.1530/endoabs.111.P90

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Endocrine Abstracts (2025) 111 P90 | DOI: 10.1530/endoabs.111.P90

BSPED2025 Poster Presentations Diabetes 4 (10 abstracts)

Reduction of high HbA1c in children and young people with type 1 diabetes mellitus through implementation of a ’high HbA1c pathway’

Emily Cooper , Charlotte Button & Chun Lim

Author affiliations

Frimley Park Hospital Camberley, United Kingdom

Introduction: This project investigated how to improve the HbA1c of Children and Young People (CYP) with Type 1 Diabetes Mellitus (T1DM) with a high HbA1c at Frimley Park Hospital (FPH).

Methods: CYP with a HbA1c ≥69 mmol/mol were placed on the ‘High HbA1c Pathway’ which involves their keyworker being informed; more frequent contact; involvement of a dietician; discussion topics and paediatric diabetes specialist nurse (PDSN) follow up in 6 weeks.

Results: 76 CYP were recorded to have a HbA1c ≥69 mmol/mol between September 2023 and October 2024. 13 CYP were excluded due to recent T1DM diagnosis or they had transitioned to adult services. 63 CYP were included in the study. At the start the average HbA1c of the CYP was 80.22 mmol/mol; average age was 13 years and 33% were on insulin pump therapy. At the end of the study 40 CYP had a HbA1c <69 mmol/mol and average HbA1c reduced to 69.05 mmol/mol. Average reduction in HbA1c was 12.64%. The greatest factor affecting the reduction in HbA1c was attendance to the 6 week PDSN follow up, which reduced HbA1c by 19.19%. The second largest factor affecting reduction in HbA1c was commencing an insulin pump which saw a 18.65% reduction in HbA1c. The reduction in CYP already on insulin pumps was less pronounced with an 11.6% reduction in HbA1c.

Discussion: Implementation of a ‘High HbA1c pathway’ for CYP with T1DM can have a positive effect in reducing high HbA1c and subsequent complications. The greatest factor affecting reduction in HbA1c was attendance to nurse-led clinics which demonstrates the importance of patient and family engagement in healthcare outcomes. Given starting insulin pump therapy was the second largest factor affecting reduction in HbA1c, a further study is underway to determine whether the improvement in HbA1c upon starting insulin pump therapy is sustained. As a result of this study the median HbA1c for all CYP with T1DM at FPH reduced from 61 mmol/mol (2023/2024) to 56 mmol/mol which places FPH in the top 5 performing units in London and the Southeast.