Children and young people with diabetes in Yorkshire: a population-based clinical audit of patient data 2005/2006.

Diabetic medicine : a journal of the British Diabetic Association

PubMedID: 19046216

McKinney PA, Feltbower RG, Stephenson CR, Reynolds C, Yorkshire Paediatric Diabetes Special Interest Group. Children and young people with diabetes in Yorkshire: a population-based clinical audit of patient data 2005/2006. Diabet Med. 2008;25(11):1276-82.
AIMS
To provide a population-based clinical audit of children and young people with diabetes, reporting outcomes, including glycaemic control, for named individual units.

METHODS
Clinical audit data on care processes and glycated haemoglobin (HbA(1c)) were collected for 1742 children and young people treated in 16 paediatric units in Yorkshire, from January 2005 to March 2006. The Yorkshire Register of Diabetes in Children and Young People provided information technology support and validation that enhanced data quality. Multi-level linear regression modelling investigated factors affecting glycaemic control.

RESULTS
An HbA(1c) measure was recorded for 91.6% of patients. The National Institute for Clinical Excellence-recommended target level for HbA(1c) of < 7.5% was achieved for 14.7% of patients. HbA(1c) was positively associated with duration of diabetes and later age at diagnosis. Patients living in deprived areas had significantly poorer control compared with those from affluent areas. Significant between-unit variation in HbA(1c) was not reflected by any association with unit size.

CONCLUSIONS
Our population-based clinical audit of children with diabetes is the product of an effective collaboration between those who deliver care and health services researchers. High levels of recording the key care process measuring diabetes control, compared with national figures, suggests collaboration has translated into improved services. The interesting association between poor diabetes control and higher deprivation is noteworthy and requires further investigation. Future audits require recording of clinical management and clinic structures, in addition to resources to record, assemble and analyse data.