Endocrine Abstracts

Background: HbA1c is an important indicator of long-term glycaemic control in CYP with established diabetes mellitus (DM). The WHO recommends that diagnosis of DM requires measurement of blood glucose, and that HbA1c is not validated as a diagnostic test in CYP. NICE guidance recommends any child with suspected Type 1 DM should have a POC BG test and same day referral to secondary care. Requesting HbA1c in primary care may delay diagnosis of Type 1 DM, leading to potentially life threatening DKA at diagnosis.

Aims: To establish the number of children without a previous diagnosis of DM having HbA1c measured, along with the clinical indications and location of requesting clinicians, and establish the incidence of potentially delayed diagnoses of DM in this cohort.

Method: Retrospective data from the Biochemistry labs of all HbA1cs performed in children <16 years over a 2 year period was obtained, and the clinical portal documentation was reviewed and analysed.

Results: 2122 HbA1cs were performed during the selected time period. 274 samples from patients with a previous diagnosis of DM and 36 samples from patients with Cystic Fibrosis undergoing annual review were excluded, leaving 1812 samples analysed. 1580 samples (87%) were from Primary care. Overall 94.3% of results were <42 mmol/mol. However, when analysed separately, 25% of HbA1cs from Secondary care were >48 mmol/mol, vs <1% in Primary care. Of those subsequently diagnosed with DM, five had a delayed diagnosis. No clinical indication was documented for 33.5% of samples. The most common stated clinical indication was lethargy. 51 patients from primary care, had clinical indication mentioning polydipsia or polyuria.

Conclusion: The majority of HbA1cs performed in primary care had no clear clinical indication. In addition, patients presenting with symptoms suggestive of Type 1 DM are having “routine bloods” arranged rather than POC glucose testing and referral to secondary care as per NICE guidance. We propose to limit this using a prompting algorithm in the electronic test requesting process for HbA1cs in under 16s, and work collaboratively with primary care in order to optimise use of resources and reduce patient risk.