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P-04-682 Routine Screening for Type 1 Diabetes in Children and Young People

Pwyllgor Deisebau | 13 Mehefin 2017 Petitions Committee | 13 June 2017

Research Briefing:

In February 2017, the Committee agreed to write to all health boards for information on their diagnosis and referral pathways for type 1 diabetes in children and young people. At the time of writing, a response from Hywel Dda Health Board is still outstanding. Key points from the responses received to date are summarised below:

GPs and other clinicians are expected to adhere to national, evidence-based guidance on the diagnosis and management of type 1 diabetes, such as that issued by NICE (National Institute for Health and Clinical Excellence).

In line with NICE guidance, a child/young person with suspected type 1 diabetes should be referred immediately (same day) to a multidisciplinary paediatric diabetes team able to confirm diagnosis and provide immediate care.

Two health boards (Abertawe Bro Morgannwg and Aneurin Bevan) noted that in cases of late diagnosis/referral, such as when a child presents in DKA, it would be routine for the GP concerned to undertake a case review to identify any learning points.

Betsi Cadwaladr Health Board highlighted the need to ensure GPs are alert to the possibility of type 1 diabetes and diabetic ketoacidosis (DKA), noting that type 1 diabetes is a relatively uncommon illness and individual GPs may not come across many cases.

Abertawe Bro Morgannwg, Aneurin Bevan and Betsi Cadwaladr highlighted that action is being taken within their areas to raise awareness of type 1 diabetes in primary care and community settings. Aneurin Bevan provided examples of this including:

regular teaching sessions with junior doctors (including GP trainees) to promote awareness of diabetes symptoms and the need for appropriate testing;

awareness raising via Neighbourhood Care Networks, and;

development of an online learning module.

Cwm Taf Health Board emphasised the importance of education, suggesting this could be targeted at the public generally and in schools. It also referred to the Children and Young People’s Wales Diabetes Network’s letter to the Health, Social Care and Sport Committee. This highlighted Cardiff University’s recent Early Detection of Type 1 Diabetes in Youth (EDDY) study, which looked at the feasibility of delivering a community educational intervention, aimed at raising awareness of the symptoms of type 1 diabetes among parents, teachers, and primary care health professionals. The Network’s letter (dated November 2016) stated that funding was being sought to extend the study in order to demonstrate whether such an intervention has an impact on DKA rates at diagnosis.

Betsi Cadwaladr Health Board highlighted the importance of a partnership approach to raise awareness and improve the early detection of diabetes, with a role for community pharmacy, Public Health Wales and voluntary sector organisations such as Diabetes UK.

The petition is predominantly concerned with the early identification of type 1 diabetes, rather than its management following diagnosis. Responses from the health boards did note that, once patients are admitted for treatment, the relevant all-Wales pathways and professional standards should be followed.

The health boards’ responses varied in level of detail, and it’s not therefore clear how consistent the approaches to promoting early diagnosis of Type 1 diabetes are across all health boards, or whether there is scope for further work in the following areas: Identification and sharing of good practice (within and across all health boards) to raise awareness and support the early identification of type 1 diabetes by frontline health professionals; Awareness and implementation of NICE guidance on the diagnosis and management of type 1 diabetes; A consistent and robust approach to case reviews where patients present in diabetic ketoacidosis (DKA); The development of ways of raising awareness of type 1 diabetes symptoms among the general public, health professionals, and in educational establishments.

Further information

The Welsh Government’s diabetes delivery plan for Wales 2016-2020 has been published since the Committee last considered this issue. This highlights the need for prompt diagnosis of type 1 diabetes to reduce the harm associated with DKA.

This is imperative for children with possible type 1 diabetes; any child who is unwell and has any features of diabetes should have an urgent capillary blood glucose check and should be referred urgently (to be seen the same day) to specialist services if diabetes is suspected.

Key service actions (set out in the delivery plan) include:

Health boards to ensure all key staff members have the knowledge to identify the risk factors and clinical features of diabetes and to undertake the appropriate diagnostic tests.

The Diabetes Implementation Group to develop educational tools for healthcare professionals to support the detection and classification of diabetes.

The Diabetes Implementation Group, in partnership with Diabetes UK, to develop an awareness campaign to facilitate the early diagnosis of type 1 diabetes in children.

‘Emergency admissions for hypoglycaemia and DKA’ is identified as one of the key service performance indicators in relation to children and young people.

Known in other health board areas as primary care clusters, these are groups of GPs working with other health and care professionals to plan and provide services locally.