Type 1 diabetes

Low staff ratios blamed for poor glycaemic control in children with T1D


Understaffing in diabetes centres is a likely reason why most Australian children with type 1 diabetes are failing to attain optimal glycaemic targets, the authors of a national workforce audit say.

A survey of staff numbers and glycaemic outcomes at 25 tertiary and regional paediatric centres in Australia has found that most multidisciplinary teams caring for children with type 1 diabetes fail to meet international benchmarks for staff resourcing as set by the International Society of Paediatric and Adolescent Diabetes.

While ISPAD recommends a minimum of 0.75 doctors per 100 patients, Australian diabetes centres have only 0.36. Likewise the recommended resourcing benchmark for diabetes nurse educators is one per 100 patients, but Australian centres fall short with an average of only 0.62 per 100.

Staffing levels are especially poor for psychologists and social workers in diabetes centres, reaching only one third of the 0.33  per 100 patients level recommended.

“Of particular note, both Australia and New Zealand have very low social work and psychology representation in their multidisciplinary teams, despite contemporary local data highlighting the high rate of mental health comorbidity,” note the authors of the study published in the Journal of Paediatrics and Child Health.

Regional centres tended to have lower numbers of doctors compared to tertiary diabetes centres (0.32 vs 0.43 per 100 patients), but had higher levels of diabetes nurse educators (0.64 vs 0.58).

Staff under-resourcing might explain why children with type 1 diabetes are still not attaining targets for glycaemia a quarter of a century after the landmark DCCT trial demonstrated the protective benefits of optimal glycaemic control, the study authors say.

Their survey found that the mean patient HbA1c was 8.2% for Australian units, with only 29% of children attaining the recommended HbA1c target of 7.5%.

The study authors, led by paediatric endocrinologist Dr Martin de Bock, from the University of Otago, note there has been no change in the rates of young patients meeting glycaemic targets since 2010 despite the increasing use of insulin pumps. Although insulin pumps were used by 41% of children managed in Australian centres, paediatric team staffing levels had not changed over the same period, they observe.

“There is an urgent need to reform models of care and workforce and to institute systematic benchmarking in both countries in order to prevent acute and chronic complications of TD1,” they write.

“Investment in an expert workforce and rigorous benchmarking is likely to be a worthwhile investment by the healthcare system in comparison to the economic and human burden of those morbidities and early mortality.

“Finally there is a clear need to further develop data sharing to enable long-term accurate benchmarking of care and outcomes.”

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