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Recommendations on back of ‘concerning’ transitional audit findings

By Editor
17th January 2019
Audits, Type 1 diabetes

A “collaborative approach” between commissioners and specialist services is being urged to improve transitional diabetes care.

On average young people with type 1 diabetes experience “deteriorations” in care processes and achievement of treatment targets as well higher rates of DKA while transitioning from paediatric to adult services.

That’s according to the second report of the National Diabetes Transition Audit (NDTA), which has issued a setof recommendations to improve care on transition to adult services and reduce variation in care.

The report, published by NHS Digital, was based on 3,800 people with type 1 diabetes and 120 with type 2 diabetes, with the data linked from the National Paediatric Diabetes Audit and National Diabetes Audit for the audit periods 2011-12 to 2016-17.

Commenting on care on transition to adult services, the report said:“It is of concern that, on average, young people with Type 1 diabetes experience deteriorations in annual care process completion, achievement of treatment targets and higher rates of DKA while transitioning from paediatric to adult services.”

On variation in care, the authors added: “However, this overall picture is the sum of considerable local service variation. Whereas most services demonstrate these adverse trends a large number show the opposite.”

Recommendations

The report urged “a collaborative approach by Commissioners and Specialist Services is needed to improve diabetes care during the transition from paediatric diabetes services to adult diabetes services”.

NDTA issued two sets of recommendations:

  • Commissioning groups and local health boards: Look at how your local paediatric and adult services compare with the others in England and Wales. If required, support them to achieve improvements in the transition of young people from paediatric to adult diabetes services
  • Specialist services adult and paediatric services: Collaboratively compare yourselves to peer services. Consider whether improvements may be accelerated through participation in the RCPCH and NDA Quality Improvement collaborative programmes.
Area Audit comments
Care processes During the year of transition to adult care the completion rate of essential care processes were similar or better than the year before transition.

Generally, there was a five to 15 per cent reduction in completion of care processes in the first year following transition to adult care which did not improve in the second or third year.

The NPDA does not include Serum Cholesterol and Serum Creatinine so this report is restricted to the remaining seven care processes.

Treatment target Overall the percentage of young people achieving a target HbA1c of <=58mmol/mol fell post transition to adult care. Three years after moving from paediatric to young adult services 10% fewer young people achieved this target.
Risk factors The important risk factor, microalbuminuria (raised UACR) is present in over 10% of young people with type 1 diabetes both before and after transition to adult care.
DKA
  • The year after transition to adult care (and the year of transition) more people admitted for DKA than during the year before transition.
  • The DKA rates during the second and third year following transfer show no difference to the year before, during or after transfer.
  • This highlights the vulnerability of the transition period.
Insulin pumps
  • The number of people using an insulin pump is relatively small.
  • Care process completion before and during and after transition to adult care is higher for people on pump than not on pump.
  • The years before and during transition see people on pump achieving a higher completion rate. Rates are not different after transfer.

To access the report, click here.

Picture credit: Nik Shuliahin

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