BSPED2018 Poster Presentations Diabetes (40 abstracts)
Standardising the management of hypoglycaemia in paediatric patients with type 1 diabetes mellitus
Afiya Andrews 1 , Catarina McLaughlin 1 , Sue Coldwell 1 , Louise Budd 1 , Rowena Remorino 2 , Vanessa Irvine 2 , Dorothy Hawes 2 , Anne Ford 1 , Helen Watson 1 , Tom Ofstad 1 , Mike Wilding 1 , Emily Hillyer 2 , Jane Edwards 2 & Sue Davies 2
1Western Sussex NHS Foundation Trust, Worthing, UK; 2Western Sussex NHS Foundation Trust, Chichester, UK.
Background: During 2017–2018 the diabetic team at our Foundation Trust participated in the RCPCH diabetes quality improvement collaborative to support work in reducing the mean HbA1c of our patient cohort. It is widely acknowledged that a consistent approach is vital in working towards HbA1c targets. One area of focus of our quality improvement work was to standardise the management of hypoglycaemia. As a team we decided to follow the BSPED hypoglycaemia guideline (2016) giving clear and personalised recommendations for treating hypoglycaemic episodes with 0.3 g/kg of fast acting carbohydrates.
Aim: The aim of this audit was to evaluate patients’ management of hypoglycaemia in accordance to BSPED guidance and to assess the impact of standardising advice on patient management and patients’ HbA1c.
Patient Population: Our Trust has a caseload of 230 patients with T1DM across two hospitals.
Method: Between January and March 2018, patients’ management of hypoglycaemia was reviewed with a questionnaire when they attended a multidisciplinary clinic. They were educated and given a patient leaflet including an individualised plan in line with BSPED guidance. Their management of hypoglycaemic episodes was subsequently re-evaluated at future clinic appointments.
Results: Of the 121 patients initially assessed, 83% used the correct threshold of blood glucose <4mmol/L to treat hypoglycaemia and 34% managed hypoglycaemic episodes appropriately. After education in clinic and the provision of a patient leaflet this improved to 90% of patients using the correct threshold. For the 52 patients who were assessed pre and post education, initially 23% had appropriate management of hypoglycaemic episodes and this improved to 60%. The individual reduction in HbA1c was not significant however over the audit period the average HbA1c dropped from 66.6 to 64.7 mmol/mol at one hospital and 70 to 66 mmol/mol at the other site.
Conclusion: This audit shows that implementing a standardised approach to the management of hypoglycaemia improves adherence to BSPED guidance and giving a consistent message with individualised written plans has a positive impact on reducing overall HbA1c.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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