Endocrine Abstracts

Audit data were prospectively collected on establishing a multidisciplinary children’s diabetes service in a small district general hospital serving a mixed urban and rural community in 1989. Only two team members DSN and paediatrician were unchanged until 2009.

The number of children diagnosed with diabetes more than doubled, with overall incidence rates of ~27/100 000. From 1998 until 2008 all newly diagnosed children were managed as outpatients unless presenting with significant keto-acidosis. Most children used twice daily pre-mixed insulins until 2002 when multiple daily injection therapy (MDI) was promoted. The first insulin pumps were introduced from 2003. By 2007 over 50% of children were using insulin pumps, while more than 30% used MDI. Metabolic control as measured by HbA1c showed steady improvement, allowing for changes in assays, from 9.79% in 1989 to 7.97% in 2006. Subsequent significant organisational changes led to a marked deterioration in HbA1c results. Further analysis has shown the best outcomes in this service were seen in pre-school children starting on insulin pumps at diagnosis, with worst control for children starting on MDI. Whilst a formal transition process to the adult service began in 1991 their control generally deteriorated for the next four years following transition.

This audit has been a driver for change and improvement as well as demonstrating evolution in the epidemiology and management of a children’s diabetes service over two decades.