Endocrine Abstracts

Introduction: In Wales, Children and Young People (CYP) are most likely to present with symptoms of Type 1 Diabetes (T1D) to primary care. Delayed diagnosis increases risk of developing life-threatening diabetic ketoacidosis (DKA). The incidence of DKA at diagnosis remains unchanged. Quality Improvement (QI) initiatives were introduced in Cardiff and Vale University Health Board (CAVUHB) in 2018 to address this. Collaborative work with primary care identified barriers to facilitate change. Initiatives included a referral pathway, sustained teaching programs and reflective learning promoted via feedback.

Objectives: This study aims to evaluate incidence of T1D and DKA in CYP across Wales over 6 years and study the success of QI initiatives to facilitate early diagnosis of T1D and reduce incidence of DKA at diagnosis.

Methods: Data analysis from the All-Wales Brecon Paediatric Diabetes Registry of all newly diagnosed CYP with T1D. Data was organised by health board, number of new T1D, age, DKA severity from pre-pandemic (1/4/18-31/3/20), pandemic (1/4/20-31/03/22) to post-pandemic (1/1/23-31/12/24). Analysis of CAVUHB data to study the incidence of delayed diagnosis, delayed presentation and feedback to primary care.

Results: Across Wales there was a 22% increase in new T1D diagnoses during the pandemic. Overall DKA incidence increased from 31% to 35% during the pandemic and post pandemic it was 33.6%. CAVUHB has the lowest mean DKA incidence over the 6 years (29%) compared to rest of Wales. There has been no increase in rate of DKA at diagnosis seen in CAVUHB over the 6 years. In CAVUHB there was improvement from pre-pandemic rate of delayed diagnosis from 17.5% to 6.7% during the pandemic and 7.9% post pandemic. The rest were delayed presentations. Post-pandemic, 81% of CYP were diagnosed promptly by capillary blood glucose tests in primary care.

Conclusions: Over the last years, incidence of DKA at diagnosis remained high. CAVUHB demonstrated a lower incidence and improvement in prompt diagnosis following the QI initiatives. Delayed presentations are a concern. Further data analysis, feedback, training and renewed public awareness campaigns across all health boards in Wales is planned.