Paediatric diabetes

Diabetes is a common long-term health condition which results when the body cannot properly control glucose (sugar) levels in the body. There are about 35,000 children in the UK under the age of 19 who have diabetes: 96% of these have Type 1 diabetes. This means that approximately one in every 500 children under the age of 19 has been diagnosed with Type 1 diabetes (Diabetes UK, 2014).

Paediatric diabetes care involves diabetes care for children under the age of 19 years old. This includes new diagnosis, regular follow-ups and the clinic reviews. Although the majority of children have type 1 diabetes, a small but growing minority have type 2 diabetes which is associated with overweight and obesity. Other forms of diabetes include as Cystic Fibrosis Related Diabetes (CFRD) or Maturity Onset Diabetes of the Young (MODY).

What is Type 1 diabetes?

Insulin is an important hormone that helps move sugar from the bloodstream into cells of the body so that it can be used for energy. In type 1 diabetes, the cells that produce insulin (found in the pancreas) are destroyed so that insulin can no longer be produced.

The treatment of type 1 diabetes, therefore, involves regularly inject insulin to ensure that sugar levels in the body are controlled properly. Type 1 diabetes is sometimes known as “insulin dependent diabetes” for this reason. Though most commonly diagnosed in children, type 1 diabetes condition can develop at any age.

What do we know?

Diabetes can have a major impact on the life of a child or young person as well as their family or carers. As well as treatment with insulin, the management of diabetes in children should include education and access to psychological support services.

Complications of diabetes include problems with blood vessels most commonly affecting the heart, kidneys, eyes and feet. Achieving tight control of blood glucose, i.e. making sure that blood sugar levels remain within the recommended limits as much as possible, is important for reducing the risk of diabetic complications.

Facts, figures, trends

It is estimated that there are between 77 and 95 children under the age of 19 with diabetes living in Slough. This figure, however, is based on applying national prevalence estimates to local population and therefore represents the best estimate rather than the true number of cases.

The National Paediatric Diabetes Audit is an annual report compiled by the Royal College of Paediatrics and Child Health (RCPCH), and compares characteristics and care outcomes according to paediatric diabetes unit. Though most Slough residents receive their paediatric care from Wexham Park Hospital, this department does treat residents of other neighbouring boroughs. Data specific to this unit, therefore, does not perfectly represent the population of Slough though may be useful to consider.

The data from Wexham Park shows that 172 patients aged under 24 attended paediatric diabetic clinics over 2013/14. The majority (41.3%) of patients were aged 10-14 years, which is similar to the national average. Unfortunately little is known about the ethnicity of patients as over two thirds of those aged under 19 treated by the unit did not have their ethnicity recorded.

Interestingly, the proportion of patients diagnosed with type 2 diabetes attending Wexham Park is over double the national average, as illustrated in Table 1.

Table 1. Paediatric Diabetic Patients According to Diabetes Type

Condition Wexham Park Hospital South Central Region National
Type 1 Diabetes 94.2%  96.9% 95.3%
Type 2 Diabetes 4.1% 1.5% 1.9%
Cystic Fibrosis related 0% 0.5% 0.4%
Monogenic types 0% 0.6% 0.3%
Other N/A 0.3% 0.5%

The latest analysed data for emergency hospital admissions due to diabetes in children (2013/14) shows a reduction in emergency admissions in line with the national reduction (Figure 2).

Figure 2. Emergency admissions for diabetes in the under 19s in Slough

fIGURE 2

NICE recommends that children and young people with type 1 diabetes should be offered a “continuing programme of education from diagnosis”. Of 155 patients treated at Wexham park over 2013/2014, 49% were offered structured education. This is higher than the national average of 45% but lower than the regional figure of 61%.

NICE guidelines also recommend timely access to mental health professionals for children and young people with type 1 diabetes. Table 2 below illustrates the proportion of patients at Wexham Park referred and seen by CAMHs. Interestingly, more referrals to CAMHs are made at Wexham Park than occur nationally, though in over a third of cases need for referral is not documented.

Table 2. Referral patterns to CAMHs

Status  Wexham Park Hospital South Central Region National
Documented that CAMHs referral not required  0%  59.4% 40.1%
CAMHs referred and seen  61.3%  21.2%  13.1%
CAMHs referred but not seen  0% 1.2%  1.5%
not documented 38.7% 18.2% 45.4%

National and Local Strategies

NICE Guidance [NG18] Diabetes (type 1 and type 2) in children and young people: diagnosis and management

What is this telling us?

There have been reductions in the number of children requiring emergency admission due to diabetes in Slough according to the latest available published data. In addition to this, acute care of children with diabetes in Slough attending Wexham Park Hospital appears to be competitive with the national average.

What are the key inequalities?

  • Routine recording of ethnicity is not done. Unless this becomes a standard practice, future research and recommendations can be skewed.
  • Although representing a small proportion of children with diabetes nationally there are increasing numbers of children and young people being diagnosed type 2 diabetes. Those with type 2 diabetes in childhood are 7 times more likely to come from the most deprived areas of the country according to NPDA analysis.

What are the unmet needs/service gaps?

According to NDA analysis of local figures, provision of continuing education and keeping records of mental health needs are current unmet needs in care of children with diabetes.

Though not a large problem at present, there is a worrying increase in the number of children developing type 2 diabetes due to unhealthy lifestyles and related to childhood obesity.

Recommendations for consideration by other key organisations

  • Lifestyle interventions are highly relevant to all the patients, and those children that are overweight /obese and therefore at a higher risk of developing Type 2 Diabetes.
  • Continue to take part in and to learn from the National Paediatric Diabetes Audit
  • Continue local partnership work between acute care clinicians, GPs in primary care, managers and commissioners (including the Central Southern Commissioning Support Unit), local patients and patient support groups would bring significant improvements to patient care in the medium to long term.

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