Endocrine Abstracts

Introduction: A diagnosis of type 1 diabetes makes a huge impact on the child and family. We believe intensive training in the first-year after diagnosis is crucial in laying a solid foundation to the lifelong management of this chronic condition. To provide this intensive support and drive reduction in HbA1c we started a quality improvement project focussing on the first year of care. Previously all patients were admitted following diagnosis of diabetes for stabilisation and education. They were seen 3 monthly in MDT clinic with variable contacts in between clinics based on need. Our goal was to develop a structured, focussed education programme with more face-to-face contacts and specific areas of education to cover at each visit.

Objectives: Develop and implement a first year of care education pathway to reduce HbA1c at 12 months after diagnosis

Methods: Creation of a first year of care structured education pathway, implementation on 1st July 2020 and analysis of HbA1c at 3 monthly intervals.

Results: There was a significant improvement in HbA1c from 2020 onwards. Mean HbA1c reduced from 60.15 to 54.93 mmol/mol at 12 months post diagnosis. Percentage achieving 48 mmol/mol at 12 months post diagnosis increased from 3.8% to 30% and the percentage of patients above 68 mmol/mol reduced from 30.7% to 6.6% before and after the intervention.

Conclusions: There was a marked improvement in HbA1c outcome from January 2020 onwards. This was prior to the intervention but the period January to June 2020 was affected by the Covid pandemic where many patients could not get the recommended 3 monthly HbA1c check. The difference in HbA1c pre intervention in 2019 and post in 2020 is considerable. There was a nearly 8-fold increase in the number of patients achieving HbA1c <48 mmol/mol and a nearly 5-fold reduction in percentage of patients with HbA1c >68 mmol/mol at 12 months post diagnosis. This has required a significant investment of time and resources to provide this level of care but it has shown clear benefit. We will continue to evaluate the longer-term outcomes for these patients and families and whether these behaviours and results are maintained.