Childhood type 1 diabetes control improves again

From diabetestimes.co.uk

Diabetes control for children has improved for the sixth year running, according to the National Paediatric Diabetes Audit (NPDA).
The report, which looked at data from all 28,439 young people with diabetes in England and Wales, also showed the number of children attending essential care checks has also risen.
However, the audit did state there is still considerable variability providing care in terms of diabetes outcomes which require better working relationships, sharing of good practice and instigation of quality improvement strategies to improve care.
Dr Justin Warner, clinical lead for the NPDA and member of the Royal College of Paediatrics and Child Heath, said: “The fact that care for children with diabetes continues to significantly improve is excellent news and is what we aim to demonstrate when delivering this audit year on year.
“We want centres delivering paediatric diabetes care to learn from best practice, share good experience and improve results, so this is heartening to see.”
The data used in the report showed the following:

• The number of children and young people with type 1 diabetes achieving excellent diabetes control has increased from 17 per cent (2013/14) to 27 per cent (2015/16).
• The number of children and young people with type 1 diabetes with poor diabetes control fell from 24 per cent (2013/14) to 18 per cent (2015/16).
• Almost all children and young people with type 1 diabetes had an HbA1c (99 per cent) and a height and weight measured (98 per cent) during the audit year.
• Two thirds of young people underwent essential foot checks (66 per cent) compared with 55 per cent in the previous year.
• Two thirds (66 per cent) were screened for complications relating to their eyes (retinopathy screening), up from 64 per cent in the previous year.
• A total of 66 per cent were screened for kidney complications (urinary albumin), an improvement from 52 per cent in the previous year.

Dr Warner added: “The impact of the improvement in blood glucose levels over the last six years should not be underestimated and will reduce the risk of future complications significantly. The improvements reflect the massive amount of work and quality improvement provided by healthcare teams, parents and patients.
“This has been supported by high level strategies including the formation of the National Regional Networks1, the Best Practice Tariff in England2, Paediatric Diabetes Health Board investment in Wales3, Quality Assurance (peer review) programmes4, national and local Quality Improvement programmes5 and National Institute for Health and Care Excellence (NICE) guidance6.
“Furthermore, the improvements seen in completion of essential health checks – foot, eye and kidney disease screening – is excellent news and means that children and young people with diabetes are receiving improved care, reducing the risk of complications and allowing early recognition and intervention where necessary.”
Despite seeing improvements, the report also recognised there remain some deficiencies in care:
There remains considerable variability between centres across England and Wales providing care in terms of diabetes outcomes which require better working relationships, sharing of good practice and instigation of quality improvement strategies to improve care.

A total of 9.7 per cent of young people with type 1 diabetes are already demonstrating early signs of  kidney disease and 13.8 per cent show early signs of eye disease putting them at increased risk of kidney failure and blindness.

Children with type 1 diabetes were more likely to be overweight or obese compared to the general population.

Children and young people living in the most deprived areas were at increased risk of diabetes complications and poor diabetes control compared to those in the least deprived areas.

Two thirds of young people aged 12  and above with type 1 diabetes are not receiving all seven recommended health checks on an annual basis – HbA1c, height and weight, blood pressure, kidney function, eye screening, foot examination, and thyroid function

Although much less common in childhood, those with type 2 diabetes tend to come primarily from non-white ethnicity, are obese and have higher blood pressure compared to those with type 1 diabetes putting them at a higher risk of long-term complications.

The audit includes specific recommendations to commissioners of health services, diabetes networks, and paediatric diabetes centres, to address the inequalities across England and Wales.

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