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Audit finds ‘disappointing’ lack of improvement in paediatric diabetes admissions

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Hospital admission rates for children and young people with diabetes have not been reduced in line with better care for the long-term condition, a major audit has warned.

It found that national improvements in diabetes control and completion of health checks had not been accompanied by reductions in the number of diabetes related admissions to hospital.

“It is disappointing to see no improvement in admission rates”

Justin Warner

The findings come from the National Paediatric Diabetes Audit (NPDA) Hospital Admissions report, published today by the Royal College of Paediatrics and Child Health.

The audit identified around 10,000 admissions for diabetes related complications per year in around 27,000 children and young people under 25 in England and Wales between 2012 and 2015.

The total number of diabetes-related admissions of children and young people in 2012-13 was 9,856 for all types of diabetes, while it was 10,058 during 2013-14, and 10,800 in 2014-15.

The audit, the latest to be published on diabetes care by the NPDA, also “consistently” identified that children and young people living in the most deprived areas had poorer diabetes outcomes than those in the least deprived areas.

In addition, this trend was “reflected” for admissions, with those in the most deprived areas being at higher risk of being admitted to hospital.

“Hospital admissions in children and young people with diabetes present a considerable burden on themselves, families and the NHS,” said the report.

“This is just one example of how nursing shortages are putting children’s lives at risk”

Fiona Smith

It stated: “Efforts to improve national diabetes control over the past six years have been very successful and the same commitment and energy driving these must now be directed towards reducing national admission rates.”

Dr Justin Warner, RCPCH’s clinical lead for the NPDA and a consultant in paediatric endocrinology and diabetes, added: “Efforts to reduce admission rates should be tailored to those most at risk, including girls, those living in the most deprived areas, and those with poor diabetes control.”

Furthermore, the audit did not find any improvement in the rate of diabetic ketoacidosis (DKA) in those with newly diagnosed type 1 diabetes across the three consecutive years they looked at.

One in four children developed DKA – a lack of insulin in the body – before they were officially diagnosed with the condition, it found.

In contrast, among those with a previous diagnosis of type 1 diabetes in England and Wales, the rate of admission to hospital with DKA at least once in a year was stable at just over 5%.

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Justin Warner

Dr Warner said it was “crucial” that clinicians were aware of the signs and symptoms of diabetes in children and young people and that greater public awareness was also needed.

“The earlier they are diagnosed, the less likely it is that they will develop DKA,” he said.

He noted that, among those already diagnosed, management of the condition was a “complex problem” requiring close collaboration between the child, family and healthcare teams.

But he said: “It is disappointing to see no improvement in admission rates, despite dramatic and continued overall improvement in diabetes care reported by the NPDA earlier this year.

“Understanding the mechanisms which may lead to an acute admission in a child with diabetes is often difficult, particularly in teenagers who are being encouraged to take on responsibility for their own care,” he added.

Fiona Smith, professional lead for children and young people’s nursing at the Royal College of Nursing, said the audit findings represented a “very serious warning… that cannot be ignored”.

“All parents need to be aware of the symptoms so it can be diagnosed before children are in such danger they need to be admitted to hospital,” she said.

“If diabetes is only diagnosed once a seriously unwell child gets to hospital then they have been badly let down,” she said. “There must be a public health campaign.”

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Fiona Smith

Ms Smith also highlighted the key role of nurses in both findings and treating cases of diabetes in young patients.

“School nurses and health visitors are paramount in raising awareness of conditions like diabetes, while children and young people’s diabetes nurse specialists are key in treating them,” she said.

“However, these roles are dwindling in number and this is just one example of how nursing shortages are putting children’s lives at risk,” she stated.

Simon O’Neill, director of health intelligence for the charity Diabetes UK, said: “We are disappointed that there has been no improvement in the numbers of children not being diagnosed with diabetes until they develop DKA, a serious condition which can be life-threatening if not treated urgently.”

However, in contrast to the report’s authors, he suggested it was “good news” that overall admissions for children with diabetes had not changed dramatically.

“We know that this group’s control of their diabetes has generally improved over the last few years, which means these children are at a lower risk of serious complications in the long run,” he said.

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