Endocrine Abstracts

Background: NICE guidance (NG18) and East & North Hertfordshire NHS Trust (ENHT) CG048 recommend that in order to prevent macrovascular cardiovascular disease, services for Children and Young People with Diabetes (CYPD) offer monitoring annually from 12 years for microalbuminuria (to detect diabetic kidney disease), hypertension and dyslipidaemia. Anecdotally, elevated blood pressure (BP) readings in clinic were often attributed to anxiety or an incorrect cuff size and were therefore rarely actioned.

Method: We conducted a retrospective audit identifying 109 patients on the ENHT CYPD patient list, aged 12-16 years in December 2021, who had at least 1 annual review following diagnosis. We sampled 41 of these patients and reviewed the Clinical Information and Patient Tracking System (CIPTS) and Integrated Clinical Environment (ICE) results system. 3 patients were excluded as they had not attended a diabetic annual review after their 12th birthday (1/41) or in the previous 18 months (2/41), leaving 38 patients.

Results: Annual monitoring for microalbuminuria was recorded for 76.3% of patients, 17.2% (5/29) had an elevated albumin creatinine ratio (ACR) of 3-30 mg/mmol. Annual blood pressure measurements had been recorded for all patients, 39.5% had consistently elevated BP readings (systolic >120mmHg in ≥3 of 4 most recent reviews). Annual monitoring for dyslipidaemia had been undertaken for 68.4% of patients, 80.8% (21/26) had total cholesterol levels ≥4.0 mmol/l at their most recent annual review. No evidence of further investigation, monitoring, diagnosis, treatment or referral to a tertiary centre was identified for patients with abnormal results in our sample.

Conclusion: All patients had annual BP measurements, however fewer provided urine or blood samples. Logistical and psychological factors contribute to reduced uptake of screening. There was no documentation to indicate abnormal results had been actioned. We presented these findings at our diabetes multidisciplinary team meeting, and will encourage manual BP training for clinical staff and a flowchart to prompt actioning of abnormal BP readings. We intend to automate recall for abnormal biochemistry results and simplify our referral process to tertiary care. We are implementing a system of continual assessment of these measures to track progressive change as our proposals are enacted.