Endocrine Abstracts

Background: National paediatric diabetes audit (NPDA) provides comparative data for local paediatric diabetes units (PDUs) on key care processes and overall HbA1c. More detailed analysis on other variables affecting HbA1c is undertaken at a national level, but not at an individual PDU level.

Objective: To determine the factors influencing glycaemic control (HbA1c levels) in young children and adolescents with Type 1 Diabetes Mellitus (T1DM).

Methods: Retrospective analysis of the local data collected for the NPDA 2014-15 in a medium sized PDU. Data was analysed using the SPSS statistical package.

Results: There were 181 patients (97 boys and 84 girls) aged 12.2±4.1 years (mean±S.D.). T1DM accounts for 96% (n=174) of cases. Non-T1DM patients (n=7) were excluded from the rest of the analyses. The average HbA1c is 8.6% (70.7±19.4 mmol/mol). 26.5% of children had an HbA1c level below 7.5% (58 mmol/mol). There was a linear relationship between age and HbA1c (r=0.106) indicating poorer control with advancing age. Adolescents, in particular, had poorer glycaemic control with a mean HbA1c 17.6 mmol/mol higher in 15–19 year olds compared to 0–5 year olds (P<0.0001). The mean HbA1c was significantly higher for those who had T1DM for 5 years and above (74.5±19.6 mmol/mol) compared to those with a duration <5 years (67.0±18.5 mmol/mol) (P=0.01). The average HbA1c for the Black population is (82.1±21.5 mmol/mol), significantly higher than and that for White population (69.7±19.5 mmol/mol) (P=0.048). This difference between the ethnic groups is more marked than the national data. Those on pump therapy (64.1±12.9 mmol/mol) have lower HbA1c levels than those on multiple daily injections (72.8±20.5 mmol/mol) (P=0.003). There is a tendency for those who are ‘overweight’ or ‘obese’ to have a higher HbA1c than those who have normal BMI (P=0.3). Age at first diagnosis and number of clinic visits per year did not seem to affect HbA1c.

Conclusions: Older children especially adolescents, black ethnic origin and a longer duration of diabetes adversely affect T1DM control and HbA1c. Those on insulin pump therapy had an improved control. Targeted measures to improve management in these at-risk groups, at a local level, are imperative. Careful analysis of NPDA data at a PDU level is a useful exercise to determine local priorities.