Diabetes control for children in England and Wales has ‘significantly improved’, finds latest NPDA report
Published: 28 Feb 2018
Latest National Paediatric Diabetes Audit (NPDA) published today by the Royal College of Paediatrics and Child Health (RCPCH) shows:
- Continued improvement in diabetes care and control over the last six years
- Number of children and young people with Type 1 diabetes achieving excellent diabetes control has increased from 17% (2013/14) to 27% (2015/16)
- Number of children and young people with Type 1 diabetes with poor diabetes control fell from 24% (2013/14) to 18% (2015/16)
- More centres delivering care are completing vital health checks on feet, kidneys and eyes
Paediatric diabetes experts say years of interventions continue to yield positive results. The average blood glucose level, (HbA1C, a marker which measures overall diabetes control), in children and young people with diabetes in England and Wales has improved for the sixth consecutive year, with more children than ever achieving excellent control. This substantially reduces the long-term risks of complications from the disease.
The NPDA, commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit programme, is published today by the RCPCH and shows that the number of children achieving excellent diabetes control has increased from 17% in 2013/14 to 27% in 2015/2016. It also found that this year, more centres delivering care are completing vital health checks monitoring the risk of developing serious complications as a result of their diabetes.
The NPDA, now in its 13th year, looked at data from all 28,439 children and young people with diabetes who attended 173 paediatric centres delivering diabetes care in England and Wales between 1 April 2015 and 31 March 2016 (100% participation rate), and found that:
- Almost all children and young people with Type 1 diabetes had an HbA1c (99%) and a height and weight measured (98%) during the audit year. Two thirds of young people underwent essential foot checks (66%) compared with 55% in the previous year
- Two thirds (66%) were screened for complications relating to their eyes (retinopathy screening), up from 64% in the previous year and
- 66% were screened for kidney complications (urinary albumin), an improvement from 52% in the previous year
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.”
He goes on to say: “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 Networks, the Best Practice Tariff in England, Paediatric Diabetes Health Board investment in Wales, Quality Assurance (peer review) programmes national and local Quality Improvement programmes and National Institute for Health and Care Excellence (NICE) guidance”
“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.”
However, despite seeing these improvements, deficiencies in care still remain.
- 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.
- 9.7% of young people with Type 1 diabetes are already demonstrating early signs of kidney disease and 13.8% 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.