Introduction: Insulin pump service has changed the outlook of diabetes management in children with diabetes. Studies have shown that better metabolic control is achievable even in patients with poor adherence to medical management. NICE in UK recommends the use of insulin pump for children with poor metabolic control, disabling hypoglycaemia and also when facing challenges with MDI insulin use. National Paediatric Diabetes Audit (NPDA) reports helps to measure our clinical performances against wider national data. Though IOM not part of NPDA cohort aims to deliver highest standards of care by comparing unit performance against NPDA outcomes.
Aims: The aim is to compare the prevalence of insulin pump users, other performance outcomes such as HbA1c and compare it against published NPDA report. Also to identify factors that helps to promote wider use of insulin pump in T1D.
Methodology: A retrospective observational study was carried out on all diabetic children managed by our Paediatric unit between April 2015March 2017. Data on key outcomes like age, HbA1c, associated conditions and acute admissions were analysed. All the results were compared to published NPDA reports for the identical period.
Results: [Combined England & Wales data] A total of 48 [M-25] children with T1D and median age was 13.2 years [range 9.2-19] during the year 2015-16. The mean HbA1c was 63.3 mmol/mol [68.3] with 90% (43/48, 27-Animas, 15-Omnipod and 1-Medtronic who moved from UK) were on insulin pump compared to 28% in England & Wales combined for the same period. The results for year 2016-17 summarised in table-1 with no published NPDA data available for comparison. Acute admissions and associated conditions in our unit over this 2 years period were same though few more coeliac diseases diagnosed in 2016-17. Table-1 summarises all the results.
|Outcomes||NPDA 201516||IOM 201516||IOM 201617|
|Total [M]||27089 ||48 ||45 |
|Pump users in %||28||90 (43/48)||87 (39/45)|
|Mean HbA1c (mmol/mol)||68.3||63.3||63.8|
|<58 mmol/mol in %||26.6||31.2||39.5|
|>80 mmol/mol in %||17.9||6.2||7.2|
Conclusions: (1) Higher rate of insulin pump usage is achievable without compromising various measured outcomes. (2) Provision of only 2 different insulin pumps helped in better utilisation of expertise and at the same time providing crucial choice for the end users (tube vs. patch pump). (3) Liberal funding by health care provider is crucial for pump services.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology