For the seventh year running, the National Paediatric Diabetes Audit shows that children living with diabetes are being helped to manage their blood glucose levels (HbA1c) and so reduce the risk of developing serious long-term complications. The findings indicate the introduction of the Best Practice Tariff for paediatric diabetes in 2011-2012 to incentivise the delivery of high-quality paediatric care to all children with diabetes, in combination with a peer-review programme, have contributed to this improvement. However, a good HbA1c does not give the whole picture of care for children living with diabetes.
The National Institute for Health and Care Excellence (NICE) says all children with diabetes should have their HbA1c checked, and children over the age of 12 years should have seven other regular health checks each year. The audit reveals a wide variation in the latter. In some areas, children receive all care processes and in others they do not receive any. This vast disparity shows there is still a long way to go to ensure that all children with diabetes are receiving good care.
One way we are tackling variation is by sharing good examples of care with healthcare professionals wanting to improve their diabetes services. We share these bright ideas so diabetes services adapt them locally. For example, the Hillingdon Hospital NHS Foundation Trust has transformed care for young people with type 1 diabetes by integrating multidisciplinary clinics and psychological therapy groups into local secondary schools. This has helped children with diabetes get the care they need more easily and reduces their time spent away from school.
Paediatric units should take a serious look at their own audit results to understand what areas of care need changing in their area, and to encourage staff to look into why children and young people may not be getting the regular checks to ensure their diabetes is well managed. For example, families may not understand why their child needs to get so many checks, or they may fear problems are uncovered. It may also be around the practical aspects of attending clinics such as appointments at unsuitable times or places. Local healthcare teams need to meet the needs of their local population which cannot be addressed nationally.
Engagement with other children’s diabetes healthcare professionals through Paediatric Diabetes Networks is helpful. We have facilitated these networks to help standardise care and share ideas of how to address barriers to good care.
On top of this, there is poorer diabetes management in children and young people living with type 2 diabetes in deprived areas. There are seven times as many children with type 2 diabetes living in the most deprived areas of the country compared with children in the least deprived areas. And the number of children with type 2 diabetes is increasing.
Variation is a concern, but it also demonstrates that good care is possible. It is vital every child with diabetes gets the support they need to manage their diabetes well, to minimise their risk of developing serious, life-limiting complications in the future. We want to see a world where diabetes can do no harm, and a multidisciplinary team effort from all healthcare professionals is essential in making this happen.
Director of policy and care improvement