Endocrine Abstracts

Introduction: NICE CG15 (2004) recommends that diabetic patients aged over twelve years receive seven key care processes. The National Paediatric Diabetes Audit (NPDA) aims to improve outcomes and quality of care in paediatric diabetes. The following describes what proportion of children with type 1 diabetes in our Paediatric Diabetes Unit (PDU) are receiving these seven key care processes in comparison to the NPDA (2013–14).

Audit Methodology: Patients aged 1–17 years with a diagnosis of diabetes for ≥1 year on 01/01/15 to 31/12/15 inclusively, were identified using the TWINKLE database. Patients with non-type one diabetes were excluded. Patients were divided into two age groups (<12 yrs and ≥ 12 yrs). Data was extracted on HbA1c, Body Mass Index, Blood Pressure (BP), Albumin Creatinine Ratio (ACR), cholesterol and foot examination. Retinopathy screening data was obtained directly from the regional diabetic retinopathy screening service. Completeness rates were calculated for each individual care process in those ≥12 years of age. A completeness rate for HbA1c and for all seven key care processes was calculated in both groups. Data was compared to the NPDA (2013–2014).

Outcomes: A total of 226 patients were identified with 30 excluded due to non-type one diabetes. HbA1c was performed in 100% of patients (98.3% NPDA). 52% (n=101) were ≥12 years of age. In this age group, HbA1c and BMI were completed 100% (93.8% and 94% respectively, NPDA). Cholesterol was performed in 97% (54.2% NPDA). 93% of patients had a BP documented (80.2% NPDA). ACR was performed in 85% of cases (48.8% in the NPDA). Foot examination was documented in 82% of patients (45.7% in the NPDA). Formal retinopathy assessment occurred in 54% (51.9% in the NPDA). All seven key care processes were completed in 30% of those aged ≥12years (16.1% NPDA). 5% of those <12 years of age had all seven key care processes completed (3% NPDA). Overall, HbA1c and BMI standards are being achieved. Other key standards, especially retinopathy screening, remain suboptimal.

Change in Clinical Practice: A proforma for annual assessment will be implemented for key care processes to be performed as standard.