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

Measuring the use of this guidance

Recommendation: 1.2.1

Offer children and young people with type 1 diabetes and their family members or carers (as appropriate) a continuing programme of education from diagnosis. Ensure that the programme includes the following core topics: - insulin therapy, including its aims, how it works, its mode of delivery and dosage adjustment - blood glucose monitoring, including targets for blood glucose control (blood glucose and HbA1c levels) - the effects of diet, physical activity and intercurrent illness on blood glucose control - managing intercurrent illness ('sick‑day rules', including monitoring of blood ketones [beta‑hydroxybutyrate]) - detecting and managing hypoglycaemia, hyperglycaemia and ketosis. [new 2015]

What was measured: Proportion of children and young people with type 1 diabetes receiving structured education.
Data collection end: March 2016
71%
Data collection end: March 2017
72%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.


Recommendation: 1.2.11

Offer children and young people with type 1 diabetes monitoring for: - thyroid disease at diagnosis and annually thereafter until transfer to adult services - diabetic retinopathy annually from 12 years - moderately increased albuminuria (albumin:creatinine ratio [ACR] 3–30 mg/mmol; 'microalbuminuria') to detect diabetic kidney disease, annually from 12 years - hypertension annually from 12 years. [new 2015]

What was measured: Proportion of children and young people aged 12 years or older who had one or more urinary albumin level reported in the audit period.
Data collection end: March 2014
48.8%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people aged 12 years or older who had one or more valid systolic and valid diastolic blood pressure measurements in the audit period (systolic pressure between 20 and 200 and diastolic pressure between 15 and 150 with both measurements taken on the same day).
Data collection end: March 2014
80.2%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people aged 12 years or older who had an eye screening or a referral for eye screening reported in the audit period.
Data collection end: March 2014
51.9%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people with type 1 diabetes in England who had a thyroid function test reported in the audit period.
Data collection end: March 2014
50%
Data collection end: March 2015
70.3%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people diagnosed with type 1 diabetes during the audit period who received screening for thyroid function.
Data collection end: March 2015
56.5%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people aged 12 years or older with diabetes who had one or more urinary albumin level reported in the audit period.
Data collection end: May 2015
52.4%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people aged 12 years or older with diabetes who had one or more valid systolic and valid diastolic blood pressure measurements in the audit period (systolic pressure between 20 and 200 and diastolic pressure between 15 and 150 with both measurements taken on the same day).
Data collection end: May 2015
82.9%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people aged 12 years or older with diabetes who had an eye screening or a referral for eye screening reported in the audit period.
Data collection end: May 2015
64.9%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people with type 1 diabetes in England who had a thyroid function test reported in the audit period.
Data collection end: May 2015
70.3%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people diagnosed with type 1 diabetes during the audit period who received screening for thyroid function.
Data collection end: May 2015
56.5%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people aged over 12 with type 1 diabetes with a complete year of care who had their urinary albumin measured.
Data collection end: March 2016
66%
Data collection end: March 2017
68.7%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people with type 1 diabetes with a complete year of care who had a thyroid screen.
Data collection end: March 2016
77.7%
Data collection end: March 2017
81.8%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people aged over 12 with type 1 diabetes with a complete year of care who had eye screening.
Data collection end: March 2016
66.2%
Data collection end: March 2017
74.4%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people with type 2 diabetes with a complete year of care who had their cholesterol measured.
Data collection end: March 2016
59.2%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people aged over 12 with type 2 diabetes with a complete year of care who had retinopathy.
Data collection end: March 2016
47.2%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people with type 1 diabetes with a complete year of care who had their blood pressure checked.
Data collection end: March 2017
92.7%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.


Recommendation: 1.2.45

At each clinic visit for children and young people with type 1 diabetes measure height and weight and plot on an appropriate growth chart. Check for normal growth and/or significant changes in weight because these may reflect changes in blood glucose control. [2004, amended 2015]

What was measured: Proportion of children and young people aged 12 years or older with diabetes who had one or more valid body mass index (height and weight) measurement reported in the audit period.
Data collection end: May 2015
94.2%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people with type 1 diabetes with a complete year of care who had their body mass index (weight/ height) measured.
Data collection end: March 2016
97.9%
Data collection end: March 2017
98.7%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.


Recommendation: 1.2.71

Offer children and young people with type 1 diabetes measurement of their HbA1c level 4 times a year (more frequent testing may be appropriate if there is concern about suboptimal blood glucose control). [2004, amended 2015]

What was measured: Proportion of children and young people with type 1 diabetes with a complete year of care who had four or more HbA1c measurements recorded in the audit year.
Data collection end: March 2017
52.9%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.


Recommendation: 1.2.72

Diabetes services should document the proportion of children and young people with type 1 diabetes in a service who achieve an HbA1c level of 53 mmol/mol (7%) or lower. [new 2015]

What was measured: Proportion of children and young people aged over 12 with type 1 diabetes who achieved a HbA1c level of 53 mmol/mol or lower.
Data collection end: March 2016
14.7%
Data collection end: March 2017
16.3%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.


Recommendation: 1.2.98

Offer children and young people with type 1 diabetes and their family members or carers (as appropriate) timely and ongoing access to mental health professionals with an understanding of diabetes because they may experience psychological problems (such as anxiety, depression, behavioural and conduct disorders and family conflict) or psychosocial difficulties that can impact on the management of diabetes and wellbeing. [2004, amended 2015]

What was measured: Proportion of children and young people with type 1 diabetes who receive a psychological assessment.
Data collection end: March 2016
68.5%
Data collection end: March 2017
74.1%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.


Recommendation: 1.3.1

Offer children and young people with type 2 diabetes and their family members or carers (as appropriate) a continuing programme of education from diagnosis. Ensure that the programme includes the following core topics: - HbA1c monitoring and targets - the effects of diet, physical activity, body weight and intercurrent illness on blood glucose control - the aims of metformin therapy and possible adverse effects - the complications of type 2 diabetes and how to prevent them. [new 2015]

What was measured: Proportion of children and young people with type 2 diabetes receiving structured education.
Data collection end: March 2016
57.8%
Data collection end: March 2017
49.4%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.


Recommendation: 1.3.20

At each clinic visit for children and young people with type 2 diabetes: - measure height and weight and plot on an appropriate growth chart - calculate BMI. Check for normal growth and/or significant changes in weight because these may reflect changes in blood glucose control. [2004, amended 2015]

What was measured: Proportion of children and young people aged 12 years or older who had one or more valid body mass index (height and weight) measurement reported in the audit period.
Data collection end: March 2014
94%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people aged 12 years or older with diabetes who had one or more valid body mass index (height and weight) measurement reported in the audit period.
Data collection end: May 2015
94.2%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people with type 2 diabetes with a complete year of care who had their body mass index (weight/ height) measured.
Data collection end: March 2016
94.4%
Data collection end: March 2017
94.1%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.


Recommendation: 1.3.28

Measure HbA1c levels every 3 months in children and young people with type 2 diabetes. [new 2015]

What was measured: Proportion of children and young people with type 2 diabetes with a complete year of care who had four or more HbA1c measurements recorded in the audit year.
Data collection end: March 2017
30.4%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.


Recommendation: 1.3.37

Offer children and young people with type 2 diabetes and their family members or carers (as appropriate) timely and ongoing access to mental health professionals with an understanding of diabetes because they may experience psychological problems (such as anxiety, depression, behavioural and conduct disorders and family conflict) or psychosocial difficulties that can impact on the management of diabetes and wellbeing. [2004, amended 2015]

What was measured: Proportion of children and young people with type 2 diabetes who receive a psychological assessment.
Data collection end: March 2016
58%
Data collection end: March 2017
61.3%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.


Recommendation: 1.3.43

Offer children and young people with type 2 diabetes annual monitoring for: - hypertension starting at diagnosis - dyslipidaemia starting at diagnosis - diabetic retinopathy from 12 years - moderately increased albuminuria (albumin:creatinine ratio [ACR] 3–30 mg/mmol; 'microalbuminuria') to detect diabetic kidney disease, starting at diagnosis. [new 2015]

What was measured: Proportion of children and young people aged 12 years or older with diabetes who had one or more urinary albumin level reported in the audit period.
Data collection end: May 2015
52.4%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people aged 12 years or older with diabetes who had one or more valid systolic and valid diastolic blood pressure measurements in the audit period (systolic pressure between 20 and 200 and diastolic pressure between 15 and 150 with both measurements taken on the same day).
Data collection end: May 2015
82.9%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people aged 12 years or older with diabetes who had an eye screening or a referral for eye screening reported in the audit period.
Data collection end: May 2015
64.9%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people aged 12 years or older with diabetes who had cholesterol levels measured in the audit period.
Data collection end: May 2015
54.2%
Data collection end: May 2015
60.8%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people with type 2 diabetes with a complete year of care who had their urinary albumin measured.
Data collection end: March 2016
51.7%
Data collection end: March 2017
56.7%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people with type 2 diabetes with a complete year of care who had their blood pressure measured.
Data collection end: March 2017
86%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people with type 2 diabetes with a complete year of care who had their cholesterol measured.
Data collection end: March 2017
66.4%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people aged over 12 with type 2 diabetes with a complete year of care who had retinopathy.
Data collection end: March 2017
54.8%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.



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