Endocrine Abstracts

Background: As per 2011–15 National Paediatric Diabetes Audit (NPDA) data set, the paediatric diabetes units (PDU) contributed data on annual lipids levels check for children and young people (CYP) over 12 years of age. Blood cholesterol were used to stratify the risk of complications of diabetes. National Institute of Health and Care Excellence (NICE) guideline NG18 did not recommend lipid screening during annual review of type 1 diabetes due to lack of robust evidence. A survey of members of Association of Children’s Diabetes Clinicians (ACDC) published in 2017 revealed significant number of respondents still measured cholesterol on annual basis. The NPDA dataset 2017 mentions annual cholesterol check in type 1 diabetes as optional.

Aim: To check if cholesterol screening in CYP with type 1 diabetes complied with NICE NG18 in our unit.

Materials and Methods: Paediatric diabetes database was used to identify CYP who had blood cholesterol checked between 1-4-16 and 31-3-17. Results were confirmed from Pathology system. Medical records of CYP with cholesterol level > 5.2mmol/L were reviewed to identify treatment strategies and subsequent cholesterol levels were followed till 28-2-18.

Results: Out of 144 CYP, 138 had cholesterol levels checked during audit period. Out of these 138 CYP, 20 (14.5%) had cholesterol level above 5.2mmol/L including 7 (5%) with levels above 6.2 mmol/L. All CYP received dietary advice. In all except one CYP, subsequent cholesterol testing revealed the levels were improving. The highest cholesterol level was 9.4mmol/L at diagnosis that reduced to 4.2 mmol/L with diabetes treatment. One CYP in late teens with cholesterol level 7.7mmol/L was started on lipid lowering medicine in transition clinic. This CYP was diagnosed with type 1 diabetes over 10 years ago and had poor compliance and control for several years.

Discussion: Our local audit revealed no benefit of routine annual cholesterol checks in CYP with established diabetes thus we have changed to a more targeted approach. In addition, it is not clear if inclusion of cholesterol checks in old NPDA data set was driving PDUs across country to do this test on annual basis.