Paediatrics: Share best practice to improve paediatric diabetes care say doctors

Positive advances in the care of paediatric diabetes in England and Wales have, for the first time in ten years, started to demonstrate some improvement in the control of children’s diabetes, according to a new report.

But whilst double the number of children are having their care processes recorded – blood or urine tests or physical examinations that should be performed annually as recommended by NICE – there remains much variability across the country.

The findings from the National Paediatric Diabetes Audit Report 2012-13, launched by the Royal College of Paediatrics and Child Health, has led to calls for diabetes units across the country to share best practice in order to ensure every paediatric diabetes unit delivers the same high quality care.

The Audit, which is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme, collected data from a total of 25,221 children and young people in England and Wales receiving care in Paediatric Diabetes Units between 2012-13. The audit found:

– A downward trend in the national median HbA1C (a blood marker relating to overall diabetes control) in comparison to the NPDA 2011-12 – representing an improvement in overall diabetes control

– A marked increase in HbA1c being recorded in England (98.6% of children under 25 compared with 89% in 2011-12) and Wales (98.9% in 2012-13 vs 87% in 2011-12)

– An increase from 6.7% in 2011-12 to 12.1% in 2012-13 in children over the age of 12 with diabetes, having all care processes recorded – this number still falls well short of the 42.4% of adults with type 1 diabetes having such care processes recorded in the adult National Diabetes Audit 2011-12

A statistical analysis of average HbA1c achieved by centres providing care, which takes into account factors such as ethnicity, social deprivation, gender, age and duration of diabetes, demonstrates that only 8% of the variability in this outcome seen across the country could be accounted for by these factors. This means that over 90% must be accounted for by other factors such as the way services are structured or delivered.

The Royal College of Paediatrics and Child Health’s Clinical Lead for the National Paediatric Diabetes Audit, Dr Justin Warner, said: “Whilst I’m very encouraged to see that for the third consecutive year there has been an improvement in the average HbA1c level for England and Wales, meaning more children’s blood sugar levels are being kept at a safe limit, our audit also found that there is still variability between the regions.

“Therefore it is not time to rest on our laurels as there’s clearly much more work to be done.

“All healthcare professionals involved in the care of children and young people with diabetes have a responsibility to ensure their patients have access to high quality care. To achieve this, I urge units to share best practice and use the data gathered from this audit to ensure as many children with diabetes as possible live as normal, and complication free, lifestyles as they can.”

The NPDA, which is funded by NHS England and the Welsh Government, also highlighted:

– Children and young people with diabetes from ethnic minority groups perform less well than those from white ethnic backgrounds – the reasons for this is still unknown

– There are more boys than girls with diabetes (12,934 vs 12,046) – type 1 being the most common form of diabetes encountered in childhood

– Just over one quarter of children and young people have an unacceptable HbA1c

In response to the data gathered from this audit and in a move to address the variability in practice, regional networks have been forged and a peer review accountability programme established.

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