Endocrine Abstracts

Background: The National Paediatric Diabetes Audit has identified inequalities in diabetes care. Children and young people (CYP) with Type 1 Diabetes Mellitus (T1DM) from both ethnic minority backgrounds and deprived areas are more likely to have reduced access to diabetes technologies and a higher HbA1c. In our service there was an inconsistent approach to the initiation of Continuous Glucose Monitoring (CGM) and use of insulin pumps. The introduction of a standardised approach to the use of technology aimed to reduce inequalities, eliminating unconscious bias and improve diabetes technology access and outcome (HbA1c).

Methods: A Plan, Do, Study, Act (PDSA) cycle was used to introduce a patient pathway ‘Getting it right from the start’. It was agreed at a team away day, ensuring team engagement. It started at diagnosis, during inpatient care. If eligible (less than 5 years of age or with a learning difficulty) real time CGM (rtCGM) was commenced immediately, all other patients were offered Freestyle libre (FSL). Each clinic appointment in the first 6 months of diagnosis had clear objectives. Those eligible, were offered an insulin pump and added to the waiting list. CGM education was integral to the consultation. The HbA1c was assessed after 6 months of diagnosis.

Results: The whole team adopted the pathway and patients with T1DM were commenced on CGM (rt or FSL) at diagnosis. No patient declined. In 11 out of 12 patients less than 12 years of age, an insulin pump was agreed. In 1 out of 6 patients greater than 12 years of age, a pump was agreed due to persistently high HbA1c. At 6 months, HbA1c before implementation (January to June 2021) the mean was 52 mmol/mol and median 55 mmol/mol and after implementation (January to June 2022) the mean was 50 mmol/mol and median 51 mmol/mol.

Conclusion: The use of quality improvement methodology enabled a consistent approach and whole team engagement. The pathway has resulted in ubiquitous access to CGM from diagnosis and improved access to insulin pumps. A structured approach to diabetes education improves outcome in CYP newly diagnosed with T1DM.