1276 Audit of HbA1c of CYP in barnet & chase farm diabetes service between 2012–19 to assess impact of carb counting at diagnosis and introduction of pump service
Year: 2021
Type: conference-abstract
Abstract: Background Type 1 diabetes (T1D) is associated with reduced life expectancy[1]. Poor metabolic control in childhood strongly correlates with premature death in adulthood[ii]. For children and young people (CYP) with T1D, improvements in glycaemic control, as measured by glycated haemoglobin (HbA1c), reduces the risk of developing long-term complications. HbA1c at 1-year post diagnosis is a strong predictor of future glycemic control[2]. Since 2016 NICE has recommended CYP with T1D aim for a HbA1c of ≤48mmol/mol. Level 3 carbohydrate counting soon after diagnosis and intensive insulin management are important tools in achieving this[3 4]. Objectives Our aim was to identify the impact of introducing carbohydrate counting from diagnosis and the development of an insulin pump service on glycaemic control. Methods Barnet and Chase Farm hospitals current caseload of CYD with TID is 165. In 2014 the trust merged with the Royal Free London NHS trust, with an additional 50–60 CYP. We conducted a retrospective audit of all CYP diagnosed with T1D within the Barnet and Chase Farm paediatric service between April 2012 and March 2019. Patients were analysed in yearly cohorts to mirror the National Paediatric Diabetes Audit cycle. HbA1c was categorised into <48, <58 and >80mmol/mol at 1-year and 2-year post diagnosis. Comparison was made between years, noting significant changes in the local service, such as the introduction of carbohydrate counting from diagnosis and the insulin pump service. Results A total of 149 CYP were diagnosed with T1D at Barnet and Chase Farm Hospitals over the period (average 21/year). 29 patients left within the first year, leaving 120 for analysis. There is improvement in glycaemic control at 1-year across the audit period (graph 1). Increasing numbers of CYP achieve target HbA1c <48mmol/mol (10% 2013 versus 31% 2019) and fewer have extremely poor control with HbA1c >80mmol/mol (26% 2013 versus 6% 2019). Improvements in patients achieving lower HbA1c is noted after the introduction of carbohydrate counting from diagnosis in 2015, whereas a reduction in very poor control is evident after the pump service began in 2017. These changes are sustained at the 2-year HbA1c (Graph 2). Mean HbA1c for the all service users improved over the same period (76.2mmol/mol to 67.7mmol/mol). Conclusions The introduction of carbohydrate counting at diagnosis and the development of a local pump service positively impacted glycaemic control of new patients with T1D at 1-year. Such early changes are likely to improve long-term HbA1c and reduce the risk of complications from diabetes. Supporting this, improvements were sustained at 2-year. HbA1c at 1-year is a useful barometer for the impact of changes to services.
Source: Abstracts
Authors: Tamsin Gannon, Esther Freeman, Stephanie Jones
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3203505629