The first national audit of children and adolescents with type 1 diabetes has highlighted a shortsighted lack of resourcing for diabetes teams.
The audit found just 27% of 3,279 young people who attend one of five major paediatric diabetes centres in the country met the APEG/ADS national guidelines target HbA1c level of less than 58 mmol/mol.
The mean HbA1c was 67mmol/mol and typically increased with age, while 3% of patients had HbA1c levels greater than 108 mmol/mol, the first national audit of its kind revealed.
Paediatric endocrinologist Professor Maria Craig from the Children’s Hospital at Westmead, said the results were disappointing but not surprising.
“It’s what we see day to day. The findings are dreadful and reflect the fact that diabetes is a complex disease to manage,” she told the limbic.
She said the problem was multifactorial and not simply about access to technology such as insulin pumps.
“It’s also about waiting times for appointments so if you have to miss an appointment you can get another one, and the availability of support such as diabetes educators, social workers and psychologists.”
“Technology won’t solve everything but anecdotally, when patients are on pumps there is an amazing impact on the anxiety around hypoglycaemic events. My impression is that they make a huge difference to glycaemic control and to the patients’ quality of life.”
“Even in young children there is anxiety around having a hypos at school or overnight. Parents run blood glucose levels higher because of this fear of a hypo.”
Professor Craig said NHMRC guidelines clearly state that all children should have access to a multidisciplinary team.
“There is a strong argument for this in terms of the prevention of complications. If we invest in these children now, there are significant benefits for the healthcare budget down the track,” she said.
A third of the children were either overweight (25%) or obese (8%) – again reflecting the complexity of the disease and its management, she said.
“Kids have to eat so their glucose doesn’t go too low. Their day-to-day eating patterns become different to other children. Again, pumps can help by increasing flexibility around eating but a multidisciplinary team would help here too.”