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More children showing early signs of serious diabetes complications, reveals new UK report

1,000 more children in England and Wales with were reported last year (2013/14) – and despite the quality of care improving, there remains significant variation across regions and between units, according to the latest National Paediatric Audit report.

Published by the , the audit also reveals that there are a ‘worryingly high’ number of young people aged 12 and over showing early signs of potentially serious complications:

  • 27.5% of young people with have high blood pressure
  • Over 7% have excess protein in their urine which indicates a high risk of future kidney disease
  • Over 14% have early signs of eye disease, putting them at risk of future blindness
  • Nearly 1 in 5 children aged 0-11 and 1 in 4 over the age of 12 who have type 1 diabetes are classed as obese

However, the audit reveals a positive story when it comes to the control of diabetes. Overall, the percentage of children and young people with excellent – which is measured by HbA1c levels – has improved steadily over the last two years. In 2012/13, 15.8% had excellent control, which rises to 18.4% in 2013/14.

Dr Justin Warner, Clinical Lead for the NPDA, said:

“On the one hand the picture is positive; the quality of care for children and young people with diabetes is improving and we’re getting better at ensuring care processes are met. Yet the challenge we face is also growing, with more children being diagnosed with diabetes and some displaying early signs of potentially serious long term health problems. This is a lifelong condition where tight overall diabetes control is important to reduce the risk of complications later in life. This requires a close partnership between healthcare professionals delivering care and children and families with diabetes”

The purpose of the audit is to analyse data on children and young people in England and Wales with diabetes – looking at prevalence, care processes and treatment compared to previous years – and identifying areas of good and best practice. This is the 11th year of the audit, and 100% of Paediatric Diabetes Units responded. The data shows:

  • A total of 26,867 children and young people with diabetes, aged 0-25 years, cared for in a Paediatric Diabetes Unit were registered in 2013/14, compared to 25,221 in 2012/13
  • Over 95% of cases of diabetes are Type 1
  • There is a much greater prevalence of diabetes in teenage years
  • The highest prevalence is in Wales and the South West region
  • Children and young people living in the most deprived areas have poorer outcomes in terms of diabetes control compared to those in the least deprived areas
  • White ethnic groups achieve better control of diabetes compared to other ethnicities

Although Type 2 diabetes only accounts for less than 5% of cases of diabetes in children and young people, the audit also reveals that those with Type 2 are 7 times more likely to come from the most deprived areas of the country compared to the least deprived.

This year, the audit makes a series of recommendations, including:

  • Funding streams should take into account regional variability when allocating resources to
  • Paediatric Diabetes Units should consider how they allocate resources based on the higher prevalence of Type 1 diabetes amongst teenagers
  • Diabetes services should benchmark themselves against other services and regional networks to learn from those where quality of care is better
  • Structured Education Programmes should be explored to avoid such wide variability in treatment target outcomes

Dr Warner said:

“It’s the aim of all healthcare professionals providing support for children and young people with diabetes to ensure – wherever they live and whatever their background – they have the best possible care. At the moment, the variability highlighted by the audit demonstrates that this is simply not the case. We have to bridge the gap between best and worst, share best practice and continue to drive up the quality of care for all patients. The results from this audit means we can recommend where resources should be targeted, identify risk factors and monitor trends – only with good data can real progress be made.”

Source

The Royal College of Paediatrics and Child Health (RCPCH)