Endocrine Abstracts

Background: Raised blood pressure (BP) in adolescents with type 1 Diabetes Mellitus (T1DM) has been associated with adverse cardiovascular outcomes independently of raised HbA1c. It is therefore of critical importance that these patients are identified early and appropriate treatment instigated. Of concerns, studies have recognised suboptimal management of hypertension in most of these young people, allowing them to succumb to complications of diabetes with hypertension in their adulthood. The aim of this audit is to assess our local practice in recognising and managing hypertension in adolescents with T1DM.

Methods: This audit reviewed recorded BP for adolescents with T1DM, aged between 12 and 16 in our trust over 12 months. The records were extracted from Twinkle Database where all clinical encounters were recorded. The primary endpoints of interest for this audit are i) frequency of BP measurements ii) intervention taken for abnormal BP.

Results: 98 patients were included in this audit. 10 patients had no BP checked or documented for 12 months. A total of 230 clinic episodes were attended by these 98 patients over the year and adolescents were found to be hypertensive in 37 of them. Out of these 37 clinic episodes, BP was subsequently rechecked within 3 months in only 12 (32%) of them. One quarter of these adolescents remained hypertensive. No clear action was documented in response to these abnormal BP recordings.

Conclusion: Our audit has identified poor awareness in monitoring hypertension in adolescents with T1DM. Only a small fraction of children with recorded episode of hypertension had appropriate follow up as recommended by the American Diabetes Association. As a consequence the service is reviewing the screening tools and the management of adolescent with borderline and actual hypertension. We are also in a process of writing a regional guideline to ensure improved detection and management of borderline and actual hypertension in adolescents with T1DM.