The fifth UK paediatric diabetes services survey: meeting guidelines and recommendations?

Abstract

Paediatric and adolescent diabetes services are rising to the challenge of providing high-quality care despite rising prevalence and increasingly complex insulin regimes. Services have improved in a number of key areas but serious deficiencies remain.

Cardiovascular Disease Risk Factors in Youth With Diabetes Mellitus

“…While rosiglitazone appeared most effective in the adolescents in TODAY, in adults, the use of agents in the thiazolidinedione class has now declined due to cardiovascular and bone density safety concerns 64,65 . However, serious adverse events did not differ between arms in TODAY.…”

“…62 A study in the United Kingdom found 83.5% compliance with lipid screening with T1DM, 63 and another in children with T2DM found that only half of the patients had lipid testing. 64 In a survey by Gosden et al, 65 only 66% of patients had their BP checked yearly, and other CVD risk factors were not addressed. The SEARCH study reported self-assessed adherence to guidelines in 1514 participants.…”

Resources and population served: a description of the Ontario Paediatric Diabetes Network

“…This rate is lower than that reported for 2008 for the United Kingdom, 44%. 13 Although we report availability of funded 24-hour support for patients using pumps, our clinical experience suggests that centres that provide this service are likely to do so for all patients regardless of their insulin regimen.…”

“…14 In the United Kingdom in 2008, 94% of centres had a diabetes specialist nurse, 88% of whom worked solely in pediatrics. 13 In the European study, the number of patients per nurse ranged from 140 to 184 across centre size, 14 and in the UK study, the median was 92, 13 considerably lower than that in the Ontario network. In the UK, 93% of clinics reported having a pediatric dietitian, and only 21% had a psychologist.…”

“…In the UK, 93% of clinics reported having a pediatric dietitian, and only 21% had a psychologist. 13 The OPDN has been instrumental in ensuring that each pediatric diabetes centre has a multidisciplinary core team. 22 However, the median patient load of diabetes nurse specialists was 244; this exceeds recommendations of the UK Royal College of Nurses (70:1) 23 and a European guideline (100:1).…”