Endocrine Abstracts

Introduction: The number of children with type 1 diabetes continues to rise by 3% per year. As part of an audit of in-patient care of children up to 16 years with diabetes, the guidelines for management of the newly diagnosed children from participating hospitals were reviewed and compared to national and international recommendations.

Methodology: Across the Oxford, Wessex and South West Paediatric Diabetes Networks 21 out of the 27 requested services submitted their current protocol for children presenting with newly diagnosed diabetes. Themes around referral, home vs hospital management, initial screening investigations, starting insulin regimen and education were examined.

Results: Referral and location: 62% highlighted the need for same day referral. 24% described admitting children for several days and 38% advocated home management. Investigation: Thyroid and Coeliac screening were advised by 95%, Islet cell antibodies 90%, anti GAD 76%, HbA1c 76% and C-peptide by 38% services. Initial Insulin Regimen: All services start some children on 0.5 units/kg per day. However, 38% vary the dose with age/puberty status, and 14% give higher doses with ketonuria. 86% advocate basal bolus regimen for all or a subgroup of patients. The percentage of total daily dose given as basal insulin varied from 20 to 60%. Almost half of the services would start primary school children on twice or trice daily regimens. Education: Diabetes team were to be informed in all protocols; and education was mentioned in all but one. The described content varied and provision of written information was mentioned in 76%.

Discussion: Local guidelines predominantly follow NICE and ISPAD recommendations. There were however a variety of initial insulin regimes and dosages across just these three regions of England. It would be preferable to have nationally agreed starting insulin regimens and achieve a validated education program.