The quality of care for infants, children and young people with diabetes is at an eight-year high, according to the results of the largest ever paediatric diabetes audit published by the Royal College of Paediatrics and Child Health. But despite improvements in care processes and outcomes for children with diabetes in England and Wales these remain significantly worse than those for adults - and Hba1c outcomes (a marker of overall diabetes control) still remain poor in comparison to some other European countries.
The National Paediatric Diabetes Audit, commissioned by the Health Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP), measures the prevalence of diabetes in children and young people across England and Wales and assesses whether the eight key care processes recommended by the National Institute for Clinical Excellence (NICE) – are being met. These include measurements of HbA1c levels, cholesterol, blood pressure and eye screening.
The Audit of 23,676 infants, children and young people with diabetes under the age of 25 found:
- Despite the majority (over 90%) having had an HbA1c level performed during the audit year, only 6% of infants, children and young people received all eight key care processes (compared to 4% in 2009/10, and 2% in 2004/05). The adult diabetes audit, reveals that well over 50% of adults with diabetes receive all the care processes.
- The percentage of infants, children and young people with diabetes whose HbA1c levels are under 7.5% (the NICE recommended target indicating diabetes is well managed) is nearly 16%, up from 14.5% in the 2009/10 audit.
- Despite this improvement, the under 7.5% HbA1c figure remains short of results from the German and Austrian Audit which demonstrates that nearly 34% of infants children and young people with diabetes achieve such a level.
The England and Wales report also found that:
- There is significant variation in levels of HbA1c across different units delivering care for infants children and young people with diabetes in England and Wales – with patients reaching the target of <7.5% ranging from 2.9% to 33.8%.
- Nearly a third of children and young people across England and Wales recorded HbA1c levels above 9.5%, putting them at risk of complications in the future.
Dr. Justin Warner, RCPCH lead and a Consultant in Paediatric Endocrinology and Diabetes, said:
'Although the proportion of patients receiving all eight care processes remains low, what we’re seeing is improvements in the recording of all eight measures independently. There is significant variation between Paediatric Diabetes Units.
'This audit will help identify areas of good practice which through developing diabetes networks, led and supported by NHS diabetes, can be shared to help drive up quality of care for infants, children and young people. In England a process of ‘peer review’ is being piloted to aid this process.
'There’s no doubt that there’s more work to be done in bringing the quality of diabetes management up to the standards of the best units – and of those other countries who are doing it well.'
The audit also identifies a worrying increase in the number of children with diabetes being admitted with diabetic ketoacidosis (DKA) – a potentially life- threatening complication that can lead to death if untreated. The incidence per 100,000 has almost doubled since 2005 from 8.5 to 15.
Dr. Warner added:
'We are concerned with the steady increase in the number of admissions for DKA, which can be caused by a number of factors such as a delay in the recognition of symptoms which if caught early could be managed at home avoiding hospital admission. It is becoming increasingly prevalent amongst young females aged 15-19 – and we need to find out exactly why and how we can bring levels down.
'This is the first year that the RCPCH has conducted the audit and it’s encouraging to see a growing response rate from units across the country. Only with good data can we really start to make inroads into improving care for the infants, children and young people with diabetes in England and Wales.'