NPDA core reports have shown wide variation in the quality of care and outcomes achieved by paediatric diabetes units (PDUs) in England and Wales. The audit was therefore commissioned to conduct spotlight audits aimed at providing some context to these findings, on topics prioritised by key stakeholders.
The topics chosen were 'the diagnosis and management of Type 2 diabetes', ‘diabetes-related technologies’ and ‘the workforce delivering children and young people’s diabetes care in England and Wales’. The spotlight audits do not, for the most part, measure practice against any particular set of standards but seek instead to highlight variability in the way services differ in their structure and delivery of care. They provide insight into everyday practice and explore how this may be related to outcome.
Type 2 diabetes spotlight report 2019-20
Published November 2021, our Type 2 diabetes spotlight audit report aimed to address a series of questions relating to the diagnosis and management of Type 2 diabetes in paediatric diabetes care:
- How many children and young people were receiving care from a PDU in 2019-20, and what were their characteristics?
- How are PDU’s making a diagnosis of Type 2 diabetes in children and young people?
- What care and treatment did children and young people receive at diagnosis?
- What proportion of children and young people are reported to be receiving NICE recommended health checks for diabetes care, and associated comorbidities, as recommended by NICE?
- Are children and young people with Type 2 diabetes demonstrating evidence of complications associated with Type 2 diabetes, including hypertension, kidney and liver disease, and are they receiving management for these?
- Type 2 diabetes in children and young people is more prevalent in the most deprived areas and amongst ethnic minorities.
- Type 2 diabetes in the young is an aggressive form of the disease, with high rates of associated comorbidities including obesity, hypertension, fatty liver disease, and kidney disease. Children and young people with the condition should receive all health checks recommended by NICE for Type 2 diabetes and associated complications.
- Small percentages of children and young people with recorded complications of Type 2 diabetes were receiving treatment for these. Paediatric diabetes teams should address complications observed according to the best available guidance for their management in children and young people.
- Most paediatric diabetes teams in England and Wales have small numbers (between 1-5) of children and young people with Type 2 diabetes accessing their services. Those with smaller numbers should develop and maintain their multidisciplinary expertise of working with this group by networking with other paediatric diabetes teams.
- Paediatric diabetes teams in England and Wales have shown commitment to the improvement of Type 2 diabetes care and outcomes by voluntarily participating in this patient level audit at the same time as facing pressures relating to the contemporaneous COVID-19 pandemic.
Type 2 diabetes resources
- Educational webinars
- Hear from NPDA Clinical Lead Justin Warner on the overview of results and recommendations from the spotlight report
- Get a case study of how Type 2 diabetes is managed at Barts Health NHS Trust from Dr Evelien Gevers, Waseema Skogen and Elizabeth Nash
- Find out about the work of the national CYP Type 2 working group including standards developed for type 2 diabetes care, from Pooja Sachdev, Vice Chair of the CYP Type 2 Working Group
- Type 2 diabetes management resources - from Barts Health NHS Trust
- Initial lifestyle advice and medical management on metformin with Type 2 diabetes (PDF)
- Problem solving sheet about exercise with Type 2 diabetes (PDF)
- Starting on insulin with Type 2 diabetes (PDF)
- Type 2 diabetes clinic appointment action plan for CYP (PDF)
- Type 2 diabetes Clinic Proforma (PDF)
- Type 2 diabetes dietetics - St. Joer equation, food allocations and example meal plans (Excel File)
- Medicines for Children leaflets
- NPDA/DUK Type 2 Diabetes Clinic Chat Report
The NPDA and Diabetes UK wanted to find out what children and young people with Type 2 diabetes thought about their care and condition so the RCPCH &US visited clinics on our behalf and asked them. This report summaries what we learned, and provides recommendations based on the comments received for making improvements to the care and diabetes education of young people with Type 2 diabetes based on what they told us.
- Animation of NPDA T2D findings
This short animation summarises the findings from the NPDA Spotlight Audit on Type 2 diabetes and the clinic chats with children and young people with Type 2 diabetes.
Diabetes-related technologies spotlight report 2017-18
Our diabetes-related technologies spotlight audit specifically aimed to:
- determine the prevalence of use of diabetes-related technologies amongst children and young people with Type 1 diabetes across England and Wales
- highlight PDU level and regional differences in access to, and funding of such technologies
- establish the type of support children and young people and their families receive when utilising diabetes-related technology
- enable benchmarking and comparison between nations, regions and PDUs of staff in terms of support for use of diabetes-related technologies for children and young people
- establish relationships between diabetes related technology usage and patient outcomes.
- Use of insulin pumps and continuous glucose monitoring (CGM) devices is associated with better diabetes management outcomes, even after controlling for the characteristics of the children and young people with diabetes using them.
- Huge variation in technology-related diabetes outcomes were observed between different PDUs, meaning that children and young people are benefitting more or less from using diabetes-related technologies to manage their condition depending on the paediatric diabetes service they attend.
- Waiting times for initiation of insulin pump therapy vary by PDU, country and region, with half of PDUs in Wales reporting a typical wait after approval of six months or greater compared to 4.3% of English PDUs.
The workforce in paediatric diabetes units spotlight report 2017-18
Our workforce spotlight audit specifically aimed to:
- establish the number of PDUs in England receiving Best Practice Tariff and the proportion of Tariff funding being used to support paediatric diabetes services
- enable benchmarking and comparison between PDUs and regions for patient access to support and services
- understand how young people with diabetes transition from PDUs into young adult services in England and Wales
- establish the number of children who are considered as being 'in need', 'looked after' or are currently on the child protection register (Wales) or have a child protection plan (England)
- determine the staffing levels of and training received by healthcare professionals involved in the management and care of children and young people with diabetes
- establish vacancy rates amongst multidisciplinary paediatric diabetes teams
- explore relationships between staffing and glycaemic control.
- Total staffing levels increased in PDUs from 24.4 to 29.2 WTE and 15.5 to 32.6 WTE in England and Wales, respectively, since 2014.
- Overall staffing increases since 2014 have been accompanied by improvements in national average HbA1c; however, at unit level, higher staffing levels were not associated with lower average HbA1c.
- Most PDUs in England were achieving BPT payments, however only 28.1% knew the percentage going directly into diabetes care in their unit (including staff costs, equipment, facilities, network management fees, etc.). Of these, the average percentage being received was 40.0%.
- Just over half of PDUs employed at least one PDSN (Paediatric Diabetes Specialist Nurse) who was a nurse prescriber. There was a statistically significant difference in mean casemix-adjusted HbA1c in services where a nurse prescriber was employed - 67.1 mmol/mol vs 68.5 mmol/mol – indicating overall better outcomes in services where they are employed.
- Over a third of PDUs had at least one vacancy, with the majority of these being unfilled for three months or longer, putting additional strain on an already busy workforce with the risk of workforce fatigue and burnout.
Unit level spotlight audit summaries
We have provided a PDF generator for the 2017-18 unit level summary reports for each spotlight audit.