An assessment of care of paediatric and adolescent patients with diabetes in a large district general hospital.
OBJECTIVE
To assess the process of clinical care and outcomes of young patients with diabetes attending clinics at a large district general hospital.


METHODS
Retrospective analysis of data obtained from 106 case notes of patients aged 12-22 years attending the paediatric, combined adolescent or adult diabetes clinics between 1998 and 2000. The frequency of follow-up, rate of admission, glycaemic control, systolic blood pressure, weight change and screening for complications were assessed.


RESULTS
The mean attendance rate was 78%. The admission rate was 91 admissions per 1000 patient years. Overall, the mean HbA1c was 9.1% with only 15% of paediatric and adolescent patients having mean HbA1c<or= 8.0%. Mean systolic blood pressure was 124 mmHg. There was a significant increase in obesity with mean weight for height at diagnosis increasing from 89% to 111% after 7 years of diabetes. Mean daily insulin dose was 1.51 U per kg body weight and decreased with increasing age. Screening for complications and associated conditions was variable: 91% for retinopathy, 86% for foot problems, 64% for thyroid dysfunction, 22% for coeliac disease and 10% for microalbuminuria. The overall rate of retinopathy was low at 4% of those screened.


CONCLUSIONS
Providing satisfactory care for young people with diabetes remains a difficult challenge. Although the complication rate observed was low in this group, the most important issues are the need for improvement in glycaemic control, weight gain and high drop-out rate.
Barton
D M
DM
Diabetes Centre, New Cross Hospital, Wolverhampton, UK. davidbarton@doctors.org.uk
Baskar
V
V
Kamalakannan
D
D
Buch
H N
HN
Gone
K
K
Wilson
E
E
Anderson
J
J
Abdu
T A M
TA
D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D001837:Body Weights and Measures; D002648:Child; D003266:Continuity of Patient Care; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000451:nursing*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006767:Hospitals, District / Q000592:standards*; D006801:Humans; D008297:Male; D010360:Patient Transfer / Q000458:organization & administration; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies
D001786:Blood Glucose; D006442:Glycated Hemoglobin