Endocrine Abstracts

Introduction: The National Paediatric Diabetes Audit (NPDA) in 2012 reported a twofold increase in the incidence of diabetes ketoacidosis (DKA) admissions from 2005/6 to 2010/11 in children and young people with type 1 diabetes mellitus (T1DM). The paediatric diabetes best practice tariff (BPT) was introduced in 2012 to incentivise provision of high quality care to those under the age of 19.

Aims: We examined DKA admission rates in children and young adults in relation to the impact of the introduction of BPT.

Methods: A retrospective audit was performed on children and young adults aged up to 25 admitted with DKA from January 2010 to April 2015.

Results: There were 359 DKA admissions in children and young adults, 165 were new diagnoses (151<19, 14 19–25 year olds). 194 admissions were in known diabetics. The number of admissions for those in transition/young adult care was four times that in paediatrics. This was mostly due to a much higher repeated admission rate, up to a maximum of 26 times. There was no difference in DKA rates pre and post BPT introduction. Mean HbA1c on admission was 98 mmol/mol for all groups. All were seen within 8 weeks of admission in paediatrics; only 25% were seen within 6 months in young adult clinic due to non-attendance.

Discussion and Conclusions: DKA readmissions were much lower in paediatric vs transitional/adult care. There was no significant difference pre and post introduction of BPT for paediatrics, however, numbers were small. Also, pre BPT, paediatric care had focused resources on those with poor control, with frequent contact, admission for stabilisation and involvement of social care/CAMHS, where needed. A systemic family therapist has been a member of the diabetes team from 2009. This audit has highlighted deficiencies in transition and young adult care and calls for the extension of BPT to age 25, in order to focus provision of resources at this vulnerable time.