National Paediatric Diabetes Audit: Admission rates remain the same despite overall improvements in care

Published: 13 Jul 2017

Admission rates for children and young people with diabetes have remained stable despite overall improvements in care, as shown in a clinical audit report published today.

View full report here

However, healthcare professionals caring for children and young people with diabetes are calling for better awareness of the symptoms as one in four children develop a dangerous complication known as Diabetic Ketoacidosis (DKA) – a lack of insulin in the body – before they are officially diagnosed with the condition, a clinical audit report published today shows. If left untreated, DKA can cause mental confusion, rapid heartbeat and breathing, sickness and unconsciousness and can be life threatening if not diagnosed and treated urgently. Amongst those with a previous diagnosis of Type 1 Diabetes in England and Wales, the rate of admission to hospital with DKA at least once in a year was stable at just over 5%.

The report also highlights the importance of focussing improvements on certain groups as, although overall admission rates remained stable, rates are higher in females, teenagers and those living in areas of deprivation.

There has been no overall improvement in rates achieved between 2012 and 2015.

The findings are from the National Paediatric Diabetes Audit (NPDA) Hospital Admissions report, published by the Royal College of Paediatrics and Child Health (RCPCH) today. The audit, commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Patient Outcomes Programme (NCAPOP), identified around 10,000 hospital admissions for diabetes related complications per year in around 27,000 children and young people under the age of 25 with diabetes between for 2012 and 2015 who are cared for in 173 paediatric centres across England and Wales.

Dr Justin Warner, RCPCH’s Clinical Lead for the NPDA and a Consultant in Paediatric Endocrinology and Diabetes, said:

“It is crucial that all doctors are aware of the signs and symptoms of diabetes in children and young people and that greater public awareness is achieved. The earlier they are diagnosed, the less likely it is that they will develop DKA.”

“In those already diagnosed with the condition, the management in childhood is a complex problem requiring close collaboration and partnership between the child, family and healthcare teams. It is disappointing to see no improvement in admission rates despite dramatic and continued overall improvement in diabetes care reported by the NPDA earlier this year.”

“Understanding the mechanisms which may lead to an acute admission in a child with diabetes is often difficult, particularly in teenagers who are being encouraged to take on responsibility for their own care.”

The audit also found that:

  • There has been no improvement in hospital admission rates for children and young people with other complications such as hypoglycaemia (low blood sugar leading to confusion and collapse if not treated urgently).
  • The risk of admission to hospital with DKA was higher amongst female adolescent children with longer disease duration and living in more deprived areas of the country. This reflects the RCPCH’s recent State of Child Health report, which found that children from the most deprived areas are much more likely to suffer from poor health, including having poorer diabetes control, than those from the most affluent. Poor blood sugar management was also a significant risk factor for hospital admission.
  •  The rate of inpatient admission of children with diabetes has remained constant over the past three years, unlike the outpatient audit which has shown improvement.
  • Children presenting to hospital tended to be: young (0-4 years), from deprived backgrounds, female, had poor diabetic control, had a longer duration of diabetes.

In November 2012, Diabetes UK launched the 4T’s campaign to raise awareness of the four most common symptoms of diabetes in children – Thirst (not being able to quench a thirst), Toilet (frequently needing to go to the toilet), Tired (feeling more tired than usual) and Thinner (losing weight). If you recognise these symptoms in a child then urgent medical advice should be sought.

Dr Warner added:

“Although parents are now more aware of the main symptoms, the 4 Ts of Type 1 diabetes, than they were a few years ago, there is still a long way to go, as parents who are aware of all four symptoms are still the exception rather than the rule and no improvements in the DKA rate at diagnosis has been shown so far.”

“Because children with Type 1 diabetes might have just one or two of the symptoms, it is important that parents know them all and also understand that if their child has any of them then they should take them straight to the GP.”

“The public and healthcare professionals who come into contact with children need to be more aware of the symptoms of diabetes, allowing earlier diagnosis and speedy treatment so as to avoid complications of DKA at diagnosis.”

Dr Warner concludes:

“A huge amount of work has been undertaken by healthcare teams, parents and patients to achieve better outcomes for children and young people in England and Wales over the last few years, which has been rewarded by continued improvements in national diabetes control.

Similar energy and effort must now be directed towards reducing admission rates, which have not improved as might have been expected.”

“Efforts to reduce admission rates should be tailored to those most at risk, including girls, those living in the most deprived areas, and those with poor diabetes control.”