More children showing early signs of serious diabetes complications, audit finds.

Over a thousand more children in England and Wales had diabetes in 2013-14 than the previous year, an audit has found, with potentially serious complications at a level described as “worryingly high.” The audit also found that, although care for children with diabetes was improving, there was considerable variation across regions and between units. The National Paediatric Diabetes Audit reported that 26 867 children and young people (aged 0-25 years) with diabetes were registered with a paediatric diabetes unit in 2013-14, up from 25 221 in 2012-13. Most (95%) had type 1 diabetes. The prevalence of diabetes varied across England and Wales and was associated with deprivation. The highest prevalence of type 1 diabetes was in Wales (220 cases per 100 000 people) and the southwest region of England (217 per 100 000), whereas type 2 diabetes was seven times more prevalent in the most deprived areas (42%) than the least deprived (6%). This year is the eleventh year of the audit but the first time it has reported markers for complications of diabetes. It found that 27.5% of young people aged 12 or over with diabetes had high blood pressure and over 7% had excess protein in their urine. Over 14% had early signs of eye disease and nearly one in four was obese. Overall just 16% of children and young people with diabetes in England and Wales received all seven of the key care processes for diabetes recommended by the National Institute for Health and Care Excellence—monitoring of HbA1c concentrations, height and weight, urinary albumin concentrations, blood pressure, and cholesterol concentrations, plus eye screening and foot examination. “Improvements in care are urgent,” said the audit. In terms of overall control of diabetes there was some good news—the proportion of children and young people achieving excellent diabetes control (defined as HbA1c <58 mmol/mol) increased from 15.8% in 2012-13 to 18.4% in 2013-14, and the percentage with a very high HbA1c (>80 mmol/mol) decreased from 25.9% in 2012-13 to 23.9% in 2013-14. However, the audit described as “alarming” the fact that HbA1c concentrations remain high in the United Kingdom compared with some other European countries “when it is known that this is a strong indicator of later micro and macrovascular risk.” Again there were differences across the country with children and young people living in the most deprived areas having poorer diabetes control than those in the least deprived areas and white ethnic groups achieving better control of diabetes than other ethnicities. The audit made a series of recommendations, including that funding should take account of regional variability and that paediatric diabetes units should consider how they allocate resources based on the higher prevalence of type 1 diabetes among teenagers. It also said that services should benchmark themselves against other services and regional networks to learn from those where quality of care was better. Justin Warner, clinical lead for the audit, said, “It’s the aim of all healthcare professionals providing support for children and young people with diabetes to ensure—wherever they live and whatever their background—they have the best possible care. At the moment, the variability highlighted by the audit demonstrates that this is simply not the case. We have to bridge the gap between best and worst, share best practice, and continue to drive up the quality of care for all patients. The results from this audit mean we can recommend where resources should be targeted, identify risk factors, and monitor trends—only with good data can real progress be made.”