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Audit reveals gaps in type 1 diabetes checks for children

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Concerns have been raised over the small percentage of children with type 1 diabetes receiving all of their recommended annual healthcare checks.

Only around a quarter of 12-year-olds with the long-term condition are receiving all seven of the recommended healthcare checks each year, according to the Royal College of Paediatrics and Child Health.

“The purpose of this audit is not to point blame but to learn from best practice”

Justin Warner

However, the warning comes against a background of overall improvements in control of the condition among younger patients, which were revealed today in the college’s 2014-15 National Paediatric Diabetes Audit.

The average blood glucose level in children with diabetes in England and Wales has reduced for the fifth consecutive year, with more children achieving excellent control, said the college.

It said the data suggested “years of interventions were finally being realised”.

The twelfth annual audit looked at data from all 27,682 children and young people who attended paediatric diabetes units in England and Wales between 1 April 2014 and 31 March 2015.

It found the number of children achieving excellent diabetes control increased from 15.8% in 2012-13 to 23.5% in 2014-15.

In addition, 98.7% of children and young people had their HbA1c measured in the audit year and 64.9% of young people with diabetes over the age of 12 had their eyes screened. It also found 52.4% were checked for urinary albumin.

But just 25.4% of 12-year-olds had all seven of the annual checks recommended by the National Institute for Health and Clinical excellence, the audit found.

“There remains considerable variation in the level of care provided”

Bridgit Turner

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 checks performed, including measures of growth, blood pressure, kidney function, cholesterol, eye screening and foot examination.

Dr Justin Warner, college member and clinical lead for the National Paediatric Diabetes Audit, said: “These health checks are important. They form part of a lifetime of screening for complications.

“Regardless of postcode, children should receive the same high level of diabetes care,” he said. “While 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.”

In addition to the recording of seven health checks, NICE guidelines also recommends that an assessment for psychological risk and screening for thyroid and coeliac disease are recorded.

The audit found that assessment for expert psychological review was undertaken in just over half of children and young people with diabetes, thyroid screening was being achieved in 70% and just under 60% for and coeliac disease screening.

Dr Warner noted that some of the low figures for the seven key checks might be the result of a failure to record that they had been completed, rather than the checks not having been carried out.

He called on commissioners to ensure paediatric diabetes units had the resources in place in order to provide high quality care, regardless of postcode, and for staff in units to “strive further to ensure all healthcare checks are recorded and adequate screening is in place”.

He 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.”

Cardiff and Vale University Health Board

Audit reveals gaps in type 1 diabetes checks for children

Justin Warner

Overall, he described the continued improvement in outcomes for children and young people with diabetes as “extremely heartening” and that investment was “paying off”.

“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,” he said.

“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,” he added.

Bridget Turner, Diabetes UK’s director of policy and care improvement, said the audit contained some “really good news” but that too many children and young people were still not achieving recommended HbA1C targets, or receiving all the checks they should.

“There remains considerable variation in the level of care provided,” she said. “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.”

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