Endocrine Abstracts

Introduction: There were concerns voiced by health care professionals (HCPs) that restrictions to healthcare delivery during the pandemic has resulted in delays in diagnosing T1D in CYP. Most CYP present with symptoms of T1D to primary care. Delay in diagnosis increases the risk of potentially life-threatening diabetic ketoacidosis (DKA). In Cardiff, we piloted QI initiatives pre-pandemic to improve early diagnosis which was introduced across the Children and Young People’s Wales Diabetes Network (CYPWDN). Early in the pandemic, we escalated responses to facilitate early diagnosis.

Objectives: To analyse the impact of the QI initiatives during the pandemic on the incidence of DKA at diagnosis across Wales. The primary objective being to develop effective pathways to facilitate early diagnosis and prevent DKA.

Methods: Data over four years from the Brecon Registry of all newly diagnosed CYP in Wales was analysed; pre-pandemic (01/04/18 – 31/03/20), pandemic (01/04/20 – 31/03/22). Key points included age at diagnosis, mortality, pH, bicarbonate and health board. At the start of the pandemic, we identified barriers facing HCPs in primary care, 111, Welsh ambulance service and developed initiatives to improve timely diagnosis. This included an updated referral pathway, triage tools/algorithms and continued feedback.

Results: There has been a 22% increase in new T1D diagnoses (n=322 to n=394). DKA incidence has increased from 31% to 35%. There was a significant increase in the severity of DKA to more than double that of the pre-pandemic period. We had one mortality due to undiagnosed T1D at the start of the pandemic. 2 of the 6 health boards who actively implemented the QI tools maintained the same DKA incidence and demonstrated a reduction in those presenting in severe DKA across the 4 years.

Conclusions: There has been a significant increase in CYP presenting in severe DKA at diagnosis in Wales. Although there was no significant reduction in overall DKA rates, two health boards have demonstrated improvement following QI initiatives between primary and secondary care. This QI programme should be implemented across other parts of Wales with a long-term plan to promote early diagnosis and reduce the incidence of DKA at diagnosis.