Background: Assessment of care and outcomes in children with diabetes requires on-going monitoring to ensure improvement.
Objective and hypotheses: To assess the current quality of care and outcomes for children and young people with diabetes in England and Wales.
Method: The National Paediatric Diabetes Audit (NPDA) collates data on the demographic characteristics, care processes and outcomes of all children and young people with diabetes under the care of paediatric diabetes units in England and Wales.
Results: In the 2013/14 data was collected on 26 598 children and young people with diabetes. Almost all (98.3%) had at least one HbA1c measurement in the audit period. However, only 16.1% (12 years and older) received all seven recommended care processes (HbA1c, BMI, BP, cholesterol, urinary albumin, eye screening and foot examination) compared to 12.1% in 2012/13. Mean (SD) HbA1c was 71.6 (17.4) mmol/mol falling from 73.0 (18.0) mmol/mol in 2012/13. 18.4% had a HbA1c <58 mmol/mol (cf. 15.8% in 2012/13) and 23.9% had a HbA1c >80 mmol/mol (cf. 25.9% in 2012/13). 14.1% (12 years and older) had abnormal eye screening and 7.1% were known to have albuminuria. 27.9% had a systolic and/or a BP above the 98th centile. < half (45.2%) were recorded as having received structured education in the past year.
Conclusion: Despite improvements in the care processes received and mean HbA1c in children and young people with diabetes most are not meeting recommended targets. Early warning markers of microvascular and cardiovascular disease are present. International benchmarking of mean (SD) HbA1c in 2011/12 showed Germany/Austria 64 (18) mmol/mol, USA 67 (15) mmol/mol cf. with England and Wales 74 (18) mmol/mol. Further progress is needed to improve long term outcomes for children and young people with diabetes in England and Wales as they progress into adulthood.
Funding: This work was supported by funding from the Healthcare Quality Improvement Partnership.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology