Endocrine Abstracts

Introduction: Outcomes of the National Paediatric Diabetes Audit have shown that patients of Black ethnic origin have poorer glycaemic control. Additional professional contacts mandated by the Best Practice Tariff aim to improve glycaemic control in paediatric patients with diabetes mellitus, but do not allow for differing needs.

Aim: To evaluate whether additional professional support for paediatric diabetic patients are targeted at those with worst glycaemic control in an ethnically diverse inner-city population.

Methods: This audit of three neighbouring London Paediatric Diabetes Centres collected data prospectively from 1/4/13 to 31/3/14 of patients aged <19 years diagnosed with type 1 diabetes for >1 year including: HbA1c, gender, age of and time from diagnosis, current age, ethnicity, townsend deprivation index, and number of additional professional contacts outside routine follow-up. Statistical analysis (significance <5%) by odds ratios, ANOVA (post hoc Tukey’s test), Student’s t-test, and Spearman’s correlations.

Results: There were 275 (M=133) patients of median (range) age 14.5 (3.6–19.7) years, HbA1c 73 (35–132) mmol/mmol from the following ethnic groups: White (63.6%), Asian (11.6%), Black (9.8%), mixed (4%), others (11%). Median HbA1c showed no gender differences (P=0.14) and correlated with time from diagnosis (P<0.001), current age (P=0.012), and number of admissions (P=0.001). Patients with poor HbA1c (>80 mmol/mmol) had significantly higher deprivation scores (1.61 (3.4) vs 0.68 (3.4), P=0.032). Although mean deprivations scores were higher in the Black (P<0.001), Asian (P<0.001), and other (P<0.001) compared with White ethnic groups, there were no differences in mean HbA1c or prevalence of poor HbA1c (>80 mmol/mmol). Median number of additional professional contacts made were 17 (0–112) and correlated negatively with factors of poorer glycaemic control: time from diagnosis (P=0.034), current age (P<0.001), and deprivation scores (P=0.027). There were no differences in the number of contacts between patients with or without poor HbA1c (>80 mmol/mmol; P=0.2).

Conclusion: In this ethnically diverse population, deprivation regardless of ethnicity is associated with poor glycaemic control. Additional patient contacts are not targeting those with the greatest needs. Local and population demands should be considered during resource allocation.