Endocrine Abstracts

Introduction: Satisfactory glycaemic control in children and teenagers with Type 1 diabetes is difficult to achieve. In Wales before 2002 the level of glycaemic control across the Principality in this age group was unknown.

Aims: To determine the level of glycaemic control in diabetic children across Wales.

To determine if glycaemic control improved from 2002 to 2007.

To identify factors that might be responsible for changes.

Methods: In November 2002 and 2007, 12 of the 14 paediatric diabetes centres in Wales supplied HbA1c results for each patient attending that centre. Other data collected included age, sex, total daily insulin dose, number of injections per day, body weight and whether that centre employed a paediatric diabetes specialist nurse (PDSN).

Results: Data on 822 (2002) and 1031 (2007) patients were obtained. Comparing data from 2002 and 2007 mean age and insulin dose (units/kg/day) were no different but body weight increased from 46.9+0.6 (mean+S.E.M.) to 48.5+0.6 kg (P<0.05). HbA1c showed a modest improvement from 9.07+0.06 to 8.88+0.05% (P=0.011) with a significant improvement in glycaemic control in the >10 yr old age group Two way ANOVA indicated differences between centres (P<0.001) and differential changes in HbA1c over time (interaction P<0.001). Five centres with no PDSN in 2002 showed significantly poorer HbA1c control than those centres with a PDSN (mean+S.E.M.) 9.5±0.11 versus 8.8±0.06 (P=0.025). In 2007 those 5 centres had improved their control (HbA1c) with each centre employing a PDSN by 2004 (mean+S.E.M.) 9.5±0.11 versus 8.69±0.08 P<0.025. Using Two way ANOVA a clear effect of new PDSN appointments on mean HbA1c was found (interaction: P=0.001).

Conclusions: In Wales overall improvement in glycaemic control in children with type 1 diabetes was achieved from 2002 to 2007. There were clear differences between centres. This analysis provides evidence supporting the role a paediatric diabetes specialist nurse plays in improving glycaemic control. The data indicates the greatest effect was in 10–14 year olds with diabetes.