Endocrine Abstracts

Introduction: Type 1 diabetes (T1D) is an increasingly prevalent long-term condition among children and young people (CYP), affecting 32,809 individuals in England and Wales (NPDA 2023–24). As diabetes technologies evolve, providing safe and consistent out-of-hours (OOH) advice requires specific expertise—particularly when the specialist diabetes team is unavailable. The Association of Children’s Diabetes Clinicians (ACDC) recommends that OOH advice be delivered by trained staff using standardised protocols, with regular service evaluation. Locally, families reported variability in the OOH advice quality, reflecting inconsistent knowledge among the acute paediatric team.

Aim: To improve the knowledge and confidence of the on-call paediatric team in delivering safe, consistent OOH advice to families of CYP with T1D.

Method: A baseline survey was conducted among resident paediatric doctors and senior nurses at a district general hospital to assess current practices and confidence in managing seven common OOH T1D scenarios. These included hypoglycaemia, hyperglycaemia, and intercurrent illness in CYP using multiple daily injections (MDI), insulin pumps, or hybrid closed-loop systems (HCLS), as well as ketone interpretation. Confidence was rated on a 5-point Likert scale.

Results: Twenty-one staff completed the pre-intervention survey. Most preferred locally agreed printed algorithms, training sessions, and digital resources. Confidence scores ranged from 2.43 to 3.43, with the lowest reported in managing hyperglycaemia on pumps/HCLS (2.43) and hypoglycaemia on pumps (2.76). In response, seven scenario-specific troubleshooting algorithms were developed by the paediatric diabetes team. Laminated copies were placed in key clinical areas, with digital versions accessible via mobile devices. A local diabetes website is in development. An interactive regional study day with workshops and case discussions is planned for paediatric trainees across Wales. A post-implementation survey was conducted following the rollout of both paper and digital formats, with ongoing Plan-Do-Study-Act (PDSA) cycles. Post-intervention, confidence improved across all domains, particularly in managing insulin pump-related issues and ketone interpretation.

Conclusion: Structured, accessible algorithms enhanced staff confidence in managing OOH T1D scenarios. This initiative supports safer, more consistent care—particularly for complex technology-assisted cases—with further improvements expected through training and digital resources. The team is happy to share the algorithms at a national level.