Type 1 diabetes

Kids with T1D not on target as centres “terribly under-resourced”


Prof Jerry Wales

The care of Queensland children with diabetes is suboptimal by several measures, according to a peer review of 14 centres that provide care for most children (97%) across the state’s public system.

The review found the mean HbA1c across the state was 9.1% – higher than the 8.3% found in a 2017 national audit of young people who attend one of the five largest paediatric diabetes centres in the country.

In the Queensland data, only 21% of patients met the national HbA1c target of <7.5% – lower than the national figure of 27%.

The study found 44% of 228 new patients had presented with diabetic ketoacidosis (DKA), suggesting that type 1 diabetes was widely under-recognised in the primary care setting.

The study also highlighted limitations in staffing levels across all disciplines and especially in psychology and social work.

Professor Jerry Wales, director of endocrinology for the Queensland Children’s Hospital, told the limbic the findings were disappointing but not surprising.

“It is possible to get really good control in smaller, more remote units and depending how you define that, some of the small units do a really good job. However there are some which are terribly under-resourced, and do very poorly in comparison to international standards.”

He said staffing was the key concern.

“There is lots of new diabetes technology but no resources made available to staff the new technology. A lot of people have had very rudimentary training, and the technology is not being used to its best advantage. So it’s not surprising that maybe 25% of kids who start CGM stop using it.”

“And indeed all the studies that have been done show that the effect that you get from technology is usually statistically significant but overall is usually of no huge clinical significance.”

“So for any individual, a 0.2% improvement in HbA1c is tiny whereas we know the effect of education and contact with educators as has happened in Germany, Australia, Sweden and Poland etcetera, has made their control 2% or even 3% better than the Australian average.”

He said the amount of money invested in the CGM program nationally would have bought 17 members of staff for diabetes services in each state and territory in Australia.

“We could have done a lot better with more staff,” he said.

The study found only four centres had pre-existing databases with which to audit their service and outcomes.

“The amount of time most centres have dedicated to diabetes is very small – medical, nursing, dietetics, psychology – and they previously haven’t had time to do the analyses or even been asked to do them.”

“Almost all of them were doing it for the first time. I think Australia badly needs to bring in universal mandatory auditing to see how these centres are doing.”

 

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