LAUSR

Background During 2017–2018 we participated in the RCPCH diabetes quality improvement collaborative to support work in reducing the mean HbA1c of our patient cohort. It is widely acknowledged that a consistent approach is vital in working towards HbA1c targets. One area of focus of our quality improvement work was to standardise the management of hypoglycaemia. As a team we decided to follow the British Society for Paediatric Endocrinology and Diabetes (BSPED) hypoglycaemia guideline (2016) giving clear and personalised recommendations for treating hypoglycaemic episodes with 0.3 g/kg of fast acting carbohydrates. Aim The aim of this audit was to evaluate patients’ management of hypoglycaemia in accordance to BSPED guidance and to assess the impact of standardising advice on patient management and patients’ HbA1c. Patient population The target population was children and young people managed for Type 1 diabetes mellitus in the NHS trust. Method Between January and March 2018, patients’ management of hypoglycaemia was reviewed with a questionnaire when they attended a multidisciplinary clinic. They were educated and given a patient leaflet including an individualised plan in line with BSPED guidance. Their management of hypoglycaemic episodes was subsequently re-evaluated at future clinic appointments. Results Of the 121 patients initially assessed, 83% used the correct threshold of blood glucose <4 mmol/L to treat hypoglycaemia and 34% managed hypoglycaemic episodes appropriately. After education in clinic and the provision of a patient leaflet this improved to 90% of patients using the correct threshold. For the 52 patients who were assessed pre and post education, initially 23% had appropriate management of hypoglycaemic episodes and this improved to 60%. Over the audit period the average HbA1c dropped from 66.6 to 64.7 mmol/mol on one site and 70 to 66 mmol/mol on the other. Conclusion This audit shows that verbal and written education on management of hypoglycaemic episodes in paediatric patients with T1DM is effective in improving the diagnosis and treatment of hypoglycaemic episodes and therefore can enhance patient care.