Paediatric diabetes experts say years of interventions are finally being realised as the average blood glucose level (HbA1C) – a marker which measures overall diabetes control - in children with diabetes in England and Wales has reduced for the fifth consecutive year with more children achieving excellent control.
The National Paediatric Diabetes Audit (NPDA) 2014/15, published today by the Royal College of Paediatrics and Child Health (RCPCH) clearly demonstrates that, overall children and young people with diabetes - the vast majority of whom have Type 1 diabetes - are achieving better control thereby reducing their lifetime risk of diabetes-associated complications such as kidney disease, blindness and amputations.
'Extremely heartening to see continued improvement in outcomes'
Dr Justin Warner, clinical lead for the NPDA and member of the Royal College of Paediatrics and Child Heath, said: "It is extremely heartening to see continued improvement in outcomes for children and young people with diabetes. There have been many changes in the landscape for paediatric diabetes over the last five years including the establishment of managed networks and quality assurance measurements.
"Furthermore, the publication of service delivery plans in England and Wales and the ‘best practice tariff’ in England has enabled Trusts and Health Boards delivering care to improve the quality of service they provide. The investment is paying off with continued quality improvement.”
'This shows strategies to improve care are working'
Bridget Turner, Diabetes UK Director of Policy and Care Improvement, said: “It is really good news that the numbers of children and young people with diabetes in England and Wales meeting their target blood glucose levels and receiving all of the recommended checks is increasing. This shows that strategies to improve care, for example the Paediatric Diabetes Best Practice Tariff, the specialist paediatric networks, and the peer review along with the hard work of Paediatric Diabetes Units, is really working."However, there are still many children and young people with diabetes who are not achieving recommended blood glucose targets, or receiving all the checks they should. There remains considerable variation in the level of care provided. This is very worrying because if children and young people are not supported to manage their diabetes well in early life, they are more likely to be at risk of debilitating and life-threatening complications in adult life such as amputations, blindness and stroke. This is why it is essential that local services continue on their improvement journey working with and supporting children and young people with Type 1 diabetes and their parents and carers, to be fully engaged in their care.”
The 12th annual audit, which looked at data from all 27,682 children and young people with diabetes who attended paediatric diabetes units in England and Wales between 1 April 2014 and 31 March 2015, also found that:• The number of children achieving excellent diabetes control increased from 15.8% (2012/13) to 23.5% (2014/15)• 98.7% of children and young people had their HbA1c measured in the audit year• Nearly two thirds (64.9%) of young people with diabetes over the age of 12 had their eyes screened• Just over half (52.4%) were checked for urinary albumin - a test to determine whether someone’s kidneys are damaged• 11.6% of young people are at increased risk of kidney disease and 13.2% at increased risk of blindness• Children with Type 1 diabetes more likely to be overweight or obese compared to the general population.
Dr Justin Warner said: “It is extremely rewarding for doctors and patients to see positive results starting to emerge after the time they have spent trying to improve diabetes care for children. The rate of improvement seen in England and Wales has exceeded that seen in some other European countries. However, we will not rest on our laurels as the variability in outcomes seen across the two nations remains excessive and ongoing improvements are still required."
Only a quarter of 12-year-olds have all seven recommended checks
The NPDA 2014/15 also found that just 25.4% of 12-year-olds have all seven recommended health care checks performed. “These health checks are important,” said Dr Warner, “they form part of a lifetime of screening for complications which, if recognised early are amenable to interventions that reduce progression.” In addition, worryingly high numbers of children over the age of 12 are already showing signs of early complications – something last year’s report also flagged.
NICE guidelines state that all children with diabetes should have their HbA1C levels checked and those over the age of 12 should have six other regular health care checks performed annually. These include measures of growth, blood pressure, kidney function, cholesterol, eye screening and foot examination.
Dr Warner continued: “Regardless of postcode, children should receive the same high level of diabetes care. So whilst completion rates for individual care processes such as HbA1c have improved, it is completely unacceptable that the same high standard isn’t reached with the six other care processes that need to be recorded.
“In reality, more children from this audit could have all seven care processes completed, service providers simply might not be writing the information down - this could be attributed to a number of reasons including a lack of time and resources. However by not doing so, it is harder to monitor and improve services and communicate efficiently between patients, their family and the different healthcare professionals who provide care. This is how an increased risk of complications becomes a real threat.”
In addition to the recording of seven health checks, NICE guidelines also recommend that an assessment for psychological risk and screening for thyroid and coeliac disease are recorded. The audit found that:• Assessment for expert psychological review is undertaken in just over half of children and young people with diabetes• Thyroid screening is being achieved in 70% of children with Type 1 diabetes and just under 60% for and coeliac disease screening.
Dr Warner added: “The purpose of this audit is not to point blame but to learn from best practice and improve diabetes care, therefore it is encouraging that year on year, we are seeing improvements made. However we know there is still much more that can be done.
“We now call on commissioners to ensure paediatric diabetes units have the resources in place in order to provide high quality care for all children, regardless of postcode. To improve better overall diabetes control and reduce the number of young people developing serious complications, we also call on staff in paediatric diabetes units to strive further to ensure all health care checks are recorded and adequate screening is in place.”