Endocrine Abstracts

Introduction: The NPDA presents data on management, treatment, and complications for all diabetes units in the country. This acts as a driver for quality improvement and aims to improve standards of diabetes care. The 2019 report identified a relatively high proportion of children with hypertension locally. An audit aimed to identify the proportion of local diabetes patients with ‘hypertension’ or ‘pre-hypertension’, and their clinical identification. The subsequent clinical management was then reviewed.

Methods: A local database for all patients over the age of 12 years with a diagnosis of diabetes was created. The following information was collected from each patient’s most recent 4 clinic appointments; sex, age at appointment, duration of diabetes, height, height centile, blood pressure (BP), and BP centile. BP readings were categorised as normal (<90th centile), pre-hypertensive (90th > 95th centile), and hypertensive (≥95th centile). Clinical records were used to assess whether the clinician had correctly identified the presence of raised BP, along with subsequent investigations and treatment.

Results: BP readings from a total of 154 patients with diabetes were reviewed. All patients had their blood pressure measured at least annually. In total, 50/154 (32%) patients were found to have normal blood pressure, 7/154 (4%) had pre-hypertension and 42/154 (27%) had hypertension. The remaining 55/154 (36%) had mixed results. In over half of cases (63%), raised BP went unidentified by clinicians. Where raised BP was recognised, further assessment and investigation was variable. 8/18 patients had 24-hour BP monitoring requested, one performed home measurements, but 9 patients had no plan given by clinicians. Additional investigations were performed as part of an annual review with no evidence that investigations were specifically requested as a result of raised BP.

Conclusion: The Paediatric Diabetes Team supports the patient and family to optimise their diabetes management, whilst monitoring for and minimising the risk of the development of complications. Monitoring of BP occurs reliably, but clinician interpretation of measurements requires improvement. Standardisation of hypertension definitions and management would be a useful step in optimising the cardiovascular health of young patients with diabetes.