Endocrine Abstracts

Background: Approximately 10% of children and young people (CYP) referred to child protection services for medical neglect in America have Type 1 Diabetes (T1DM). Little published evidence exists comparing glucose control in CYP with safeguarding concerns to those without, therefore guidance on management is lacking.

Aims: To assess glucose control in CYP with T1DM and safeguarding concerns.

Methods: Data from electronic records of paediatric patients with T1DM at a large London hospital between Dec 2021 and 2022 were analysed. HBA1c readings, diabetes-related admissions, insulin administration and glucose monitoring methods, appointments and postcodes were recorded. Those with concerns were categorised into Child Protection Plan (CPP), Child in Need, Early Help and ‘local concern’, allowing further comparison. The same cohort was analysed in June 2024 after changes in hybrid closed-loop system eligibility.

Results: Of 155 active patients, 18 had documented safeguarding concerns (11.6%). This group had significantly higher HbA1C readings (10.0% vs 8.3% [P <.001]) and significantly more admissions and incidents of diabetic ketoacidosis. They had more out-of-clinic contact attempts and higher outpatient non-attendance rates. Children on CPPs had the highest HBA1c results. 6% (1/18) of the safeguarding group had an insulin pump with continuous glucose monitoring (CGM) compared to 27% (38/142) of the remaining patients. Those with insulin pumps and/or CGM had significantly lower HBA1c readings. 1 more patient in the safeguarding group had a hybrid closed-loop system following changes in eligibility.

Conclusions: CYP with T1DM and safeguarding concerns have significantly worse glucose control and reduced access to insulin pumps and CGM. These patients require frequent contact attempts with families, schools, GPs and social workers to facilitate engagement. All units should have a register of those with concerns to be discussed regularly within the multidisciplinary team. Individual management plans and out-of-hospital appointments may enable better engagement. These CYP should be enabled to use hybrid closed-loop systems safely. Successful management strategies should be shared between centres and safeguarding data shared with the national paediatric diabetes audit. A separate medical neglect category for child safeguarding, as in other countries, may enhance support from social services with targeted interventions for those with chronic illnesses.