The NPDA analyses information provided by health care professionals about the wellbeing of children and young people with diabetes mellitus being cared for in paediatric diabetes centres in England and Wales.
This year, the national report has found further improvements in blood glucose levels and this follows a steady downward trend over the last 10 years. Glycosylated haemoglobin (HbA1c), a marker of blood glucose levels, has improved from a country average of 64.0 mmol/mol to 61.5 mmol/mol between 2017/18 and 2018/19. Hba1c can be related to the risk of developing complications from diabetes and this reduction considerably reduces that risk.
There have also been improvements in the completion rates for the recommended health checks for diabetes with almost 90% being performed within the audit year. The percentage of those young people aged 12 and above receiving all seven health checks recommended by the National Institute for Health and Care Excellence for Type 1 diabetes increased from 49.8% in 2017/18 to 55.2% in 2018/19.
Despite these overall national improvements, this latest NPDA report shows evidence on continuing variability across centres in these outcome measures. Although some of this can be explained by differences in deprivation and ethnicity, the majority remains unexplained. These differences are being addressed by the Paediatric Diabetes Quality Programme delivered by the RCPCH, with an aim to aid improvements.
The report also demonstrates a rise in the use of various technologies to deliver diabetes care across the nations with almost 40% now using an insulin pump. However, despite clear indications that usage of technology is associated with lower HbA1c, there remain inequalities in access to such equipment. The gap between pump usage amongst children and young people with Type 1 diabetes living in the most and least deprived areas has increased from almost 8% in 2014/15 to just over 13% in 2018/19. Further work is needed to understand this discrepancy.
Professor Justin Warner, NPDA Clinical Lead, commented:
The State of Child Health report published by the RCPCH earlier this month highlighted that diabetes is an area where we have made huge strides. The improvements seen in this year’s NPDA report confirm this and are the result of a really concerted effort from so many people in this field, sharing what works and what doesn’t and continually striving to enhance the care of young people with diabetes.
However, variability and inequality still play a big factor and this needs addressing at local level. It will be aided by participation in the Quality Programme and working within networks.
The numbers of children and young people with Type 2 diabetes receiving care within paediatric diabetes services continues to rise with 790 being registered to the NPDA in 2018/19. For many children, the development of Type 2 diabetes can be prevented with lifestyle changes but Professor Warner pointed out that families need support to make the changes needed: “The increasing numbers of children and young people with Type 2 diabetes within the audit highlights the need for urgent action from government to help them lead healthier lives. Investment in preventative health services must be prioritised. Right now, people have fewer places to go to get advice and support.”
Professor Russell Viner, President of the RCPCH, commented:
Service providers and commissioners must work with their local communities to understand the challenges associated with good diabetes management so that these may be targeted, and solutions funded. This report shows how discrepancies in access to technologies which are contributing to variation in outcomes, and this must be addressed.
The National Paediatric Diabetes Audit is funded by NHS England and the Welsh Govt and commissioned by the Healthcare Quality Improvement Partnership (HQIP).