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Type 1 diabetes: diagnosis and management of type 1 diabetes in children, young people and adults [CG15]

Measuring the use of this guidance

Recommendation: 1.2.3.1

Children and young people with type 1 diabetes should be offered the most appropriate insulin preparations (rapid-acting insulin analogues, short-acting insulins, intermediate-acting insulins, long-acting insulin analogues or biphasic insulins) according to their individual needs and the instructions in the patient information leaflet supplied with the product, with the aim of obtaining an HbA1c level of less than 7.5% without frequent disabling hypoglycaemia and maximising quality of life.

What was measured: Children who have HbA1c < 7.5% in last year [Eng+Wales]
Data collection end: March 2011
15.8%
Data collection end: March 2012
17.4%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.


Recommendation: 1.3.5.1

Children and young people with type 1 diabetes should be offered screening for: • coeliac disease at diagnosis • thyroid disease at diagnosis and annually thereafter until transfer to adult services • retinopathy annually from the age of 12 years • microalbuminuria annually from the age of 12 years • blood pressure annually from the age of 12 years

What was measured: Children / Young people with diabetes who had their BP measured
Data collection end: March 2010
58.8%
Data collection end: March 2011
62.7%
Data collection end: March 2012
67.7%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Children / Young people with diabetes who had urinary albumin measured
Data collection end: March 2010
36.5%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Children / Young people with diabetes who had urinary albumin measured
Data collection end: March 2011
40.3%
Data collection end: March 2012
40.7%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.


Recommendation: 1.3.5.3

Children and young people with type 1 diabetes should be offered: • annual foot care reviews • investigation of the state of injection sites at each clinic visit.

What was measured: Children / Young people with diabetes who had foot examination
Data collection end: March 2010
24.5%
Data collection end: March 2011
31.9%
Data collection end: March 2012
34.4%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.


Recommendation: 1.3.5.4

Children and young people with type 1 diabetes and their families should be informed that, as for other children, regular dental examinations[4] and eye examinations (every 2 years) are recommended.

What was measured: Children / Young people with diabetes who had eye screening
Data collection end: March 2010
25.8%
Data collection end: March 2011
35.8%
Data collection end: March 2012
36.9%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.


Recommendation: 1.3.5.5

Children and young people with type 1 diabetes should have their height and weight measured and plotted on an appropriate growth chart and their body mass index calculated at each clinic visit. The purpose of measuring and plotting height and weight and calculating body mass index is to check for normal growth and/or significant changes in weight because these may reflect changing glycaemic control.

What was measured: Children / Young people with diabetes who had BMI checked in the last year
Data collection end: March 2010
70.2%
Data collection end: March 2011
75.3%
Data collection end: March 2012
64.7%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.


Recommendation: 1.9.2.1

Adults with type 1 diabetes should be advised that maintaining a DCCT-harmonised HbA1c below 7.5% is likely to minimise their risk of developing diabetic eye, kidney or nerve damage in the longer term.

What was measured: Patients with T1DM who have HbA1c < 58 mmol/mol (7.5%)
Data collection end: March 2010
28.7%
Data collection end: March 2011
28.1%
Data collection end: March 2012
27%
Area covered: National
Source: Health and Social Care Information Centre. National Diabetes Audit.


Recommendation: 1.10.1.1

Arterial risk factors should be assessed annually, and the assessment should include: • albumin excretion rate • smoking • blood glucose control • blood pressure • full lipid profile (including HDL and LDL cholesterol and triglycerides) • age • family history of arterial disease • abdominal adiposity.

What was measured: Proportion of patients with type 1 diabetes who had their urine albumin checked within the last year.
Data collection end: March 2010
56.2%
Data collection end: March 2011
58.4%
Data collection end: March 2012
59.2%
Area covered: National
Source: Health and Social Care Information Centre. National Diabetes Audit.

What was measured: Patients with T1DM who had smoking status checked in the last year
Data collection end: March 2010
80.8%
Data collection end: March 2011
78.6%
Data collection end: March 2012
79%
Area covered: National
Source: Health and Social Care Information Centre. National Diabetes Audit.

What was measured: Patients with T1DM who had HbA1c checked in the last year
Data collection end: March 2010
85.7%
Data collection end: March 2011
86%
Data collection end: March 2012
83%
Area covered: National
Source: Health and Social Care Information Centre. National Diabetes Audit.

What was measured: Patients with T1DM who had cholesterol checked in the last year
Data collection end: March 2010
79.1%
Data collection end: March 2011
78.8%
Data collection end: March 2012
77.8%
Area covered: National
Source: Health and Social Care Information Centre. National Diabetes Audit.


Recommendation: 1.10.3.1

Intervention levels for recommending blood pressure management should be 135/85 mmHg unless the person with type 1 diabetes has abnormal albumin excretion rate or two or more features of the metabolic syndrome (see Section 1.10.1.3), in which case it should be 130/80 mmHg. See also Sections 1.11.2.5–7.

What was measured: Patients with T1DM who have BP target of <140/80 for patients without eye, kidney or vascular disease (EKV-) and target of <130/80 applied to patients with recorded eye, kidney or vascular disease (EKV+)
Data collection end: March 2010
49.1%
Data collection end: March 2011
49.9%
Data collection end: March 2012
51.9%
Area covered: National
Source: Health and Social Care Information Centre. National Diabetes Audit.



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