Type 1 diabetes is an increasingly common childhood condition in the UK, according to the State of Child Health Report 2017. Despite the negative key messages that poor management in childhood can have severe long-term health implications and that those from deprived and ethnic minority backgrounds have poorer diabetes control, it found that there has been an increase in the proportion of children and young people with HbA1c levels below the target of 58 mmol/mol (7.5%) in England and Wales since 2010–11, and a corresponding decrease in those with poor control (>80 mmol/mol; 9.5%).
In England in 2014–15, 24% of children and young people had HbA1c <58 mmol/mol (7.5%); in 2010–11 just 15% had met the target. There was no overall change in Wales during this time, with 18% of children and young people achieving target blood glucose levels. There was a reduction in poor control in both countries, however – 8% in England and 2% in Wales. In Scotland, data are not directly comparable, but 13.8% of children and young people under 15 years had an HbA1c level below the target in 2016.
Data used in the report came from the National Paediatric Diabetes Audit (NPDA) for children and young people aged 0–24 years. The 58 mmol/mol HbA1c target used was set by NICE, and was lowered to 48 mmol/mol (6.5%) in August 2015.
Improvements and actions going forward
Improvements can be made, according to the report. The four nations’ data are not currently comparable and routine outcome data at a national level through audits is essential to support quality improvement. Further work is needed to improve diabetes control at individual, clinic and network levels. The report advocates all children and young people having access to the full range of intensive insulin therapies and appropriately tailored education and that transition to adult care be a priority. It also points out that schools have a major role to play in supporting children and young people with type 1 diabetes.
The report gives five key actions going forward:
- To strengthen research into the underlying causes of diabetes and ways to effectively manage it.
- To collect comparable data across the UK to give a UK-wide overview of the care and management of diabetes.
- To ensure joined-up diabetes care that meets children’s needs, including appropriate transition to adult care.
- To ensure full implementation of the updated NICE guidance for HbA1c levels and NPDA care management recommendations.
- To decrease stigma and discrimination by improving diabetes education for children, young people, their families and healthcare and education professionals.
Recent data are more positive
Major reports such as this often have old data by the time they are published. The most recent NPDA report has shown the first true improvement in HBA1c in both England and Wales. The trajectory of this improvement is impressive. Adopting the new NICE standards along with other quality measures, such as structured education, is at last resulting in the desired improvement.
Unfortunately there are still outliers to this story. The multidisciplinary team caring for children and young people with diabetes should reflect on their results and seek support from others in their network to help further their improvement.
