title: An Audit of Clinical Practice in a Single Centre in Kuwait: Management of Children on Continuous Subcutaneous Insulin Infusion and Cardiovascular Risk Factors Screening.
abstract: OBJECTIVE
  To audit the current clinical practice of continuous subcutaneous insulin infusion (CSII) for the treatment of type 1 diabetes mellitus (T1D) in children and adolescents attending a single centre in Kuwait.
  
  
  METHODS
  A one year retrospective audit was performed in children and adolescents with T1D on CSII, who attended the paediatric diabetes clinic, Dasman Diabetes Institute during 2012. The primary outcome measure was glycaemic control as evidenced by glycated haemoglobin (HbA1c) level and the secondary outcome measures were the frequency of monitoring of the risk for microvascular complications and occurrence of acute complications and adverse events.
  
  
  RESULTS
  58 children and adolescents (mean age ± SD: 12.6 ± 4.1 years) were included. Mean HbA1c at baseline was 8.8% (72.7 mmol/mol) and 8.9% (73.8 mmol/mol) at the end of a 12 months observation period. Children with poor control (HbA1c >9.5% (80 mmol/mol) had a significant 1.4% reduction in HbA1c compared with the overall reduction of 0.1% (p=0.7). Rate of screening for cardiovascular risk factors and for long term complications were well documented. However, there was underreporting of acute complications such as severe hypoglycaemia and diabetic ketoacidosis. Only 1.7% of patients discontinued the pump.
  
  
  CONCLUSIONS
  There was no significant change in HbA1c values at the end of 12 months follow up. However, HbA1c values in poorly controlled children improved. CSII requires care by skilled health professionals as well as education and selection of motivated parents and children.
authors.affiliation: Dasman Diabetes Institute, Al-Amiri Hospital, Faculty of Medicine, University of Kuwait, Kuwait, Kuwait.
authors.forename: Dina
authors.initials: D
authors.lastname: Omar
authors.affiliation: Dasman Diabetes Institute, Al-Amiri Hospital, Faculty of Medicine, University of Kuwait, Kuwait, Kuwait.
authors.forename: Hala
authors.initials: H
authors.lastname: Alsanae
authors.affiliation: Dasman Diabetes Institute, Al-Amiri Hospital, Faculty of Medicine, University of Kuwait, Kuwait, Kuwait.
authors.forename: Mona
authors.initials: M
authors.lastname: Al Khawari
authors.affiliation: Dasman Diabetes Institute, Al-Amiri Hospital, Faculty of Medicine, University of Kuwait, Kuwait, Kuwait.
authors.forename: Majedah
authors.initials: M
authors.lastname: Abdulrasoul
authors.affiliation: Dasman Diabetes Institute, Al-Amiri Hospital, Faculty of Medicine, University of Kuwait, Kuwait, Kuwait.
authors.forename: Zahraa
authors.initials: Z
authors.lastname: Rahme
authors.affiliation: Dasman Diabetes Institute, Al-Amiri Hospital, Faculty of Medicine, University of Kuwait, Kuwait, Kuwait.
authors.forename: Faisal
authors.initials: F
authors.lastname: Al Refaei
authors.affiliation: Dasman Diabetes Institute, Al-Amiri Hospital, Faculty of Medicine, University of Kuwait, Kuwait, Kuwait.
authors.forename: Kazem
authors.initials: K
authors.lastname: Behbehani
authors.affiliation: Dasman Diabetes Institute, Al-Amiri Hospital, Faculty of Medicine, University of Kuwait, Kuwait, Kuwait.
authors.forename: Azza
authors.initials: A
authors.lastname: Shaltout
keywords: Audit; Continuous subcutaneous insulin infusion; Diabetes Control and Complications Trial (DCCT); Diabetes pump therapy; Glycated haemoglobin (HbA1c); Hypoglycaemia; Type 1 diabetes mellitus