Endocrine Abstracts

Introduction: The pandemic resulted in changes in delivery of healthcare. Most children and young people (CYP) present with symptoms of T1D for the first time to primary care. Delayed diagnosis is common and associated with risk of life-threatening diabetic ketoacidosis (DKA). In Cardiff, we had a pre-pandemic QI project to improve early diagnosis of T1D. We escalated responses, introduced initiatives to facilitate early diagnosis.

Aim: To develop effective pathways to facilitate early diagnosis of T1D during the pandemic.

Methods: At the start of the pandemic, we identified barriers facing healthcare professionals (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. We raised public awareness through school social media and health board channels. Two audit cycles over four years: Retrospective case note analysis of all newly diagnosed CYP in Cardiff; pre-pandemic (01/04/18 – 31/03/20), pandemic (01/04/20 – 31/03/22). Key points included delayed diagnosis, presentation, appropriate testing and referral.

Results: Pre-pandemic: Most children presented to primary care, 7 had delayed diagnosis, 6/7 were due to triage delays, 1 had fasting blood glucose test resulting in delay. Pandemic: An increase in the number newly diagnosed, 4 had delayed diagnosis, 2 due to delayed triage. The 4 in severe DKA were delayed presentations to HCPs and promptly diagnosed, 2 were assumed to have COVID symptoms. During the pandemic 91% had POC testing and prompt referral in comparison to 75% pre-pandemic. There was no increase in DKA rates during the pandemic.

Conclusions: During the COVID-19 pandemic, we demonstrated an improvement in prompt diagnosis of T1D in Cardiff following collaborative working between primary and secondary care. Delayed presentation resulted in severe DKA despite public awareness campaigns. Data analysis, feedback, training across Wales is planned with a long-term objective to reduce the incidence of DKA at diagnosis.