An assessment of care of paediatric and adolescent patients with diabetes in a large district general hospital

Aims 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 HbA(1c) was 9.1% with only 15% of paediatric and adolescent patients having mean HbA(1c) less than or equal to 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.