6255 Diabetic nephropathy in the pediatric population at a peripheral hospital

Objectives Diabetic nephropathy (DN) is one of the most common microvascular complications and affects up to 40% of type 1 Diabetes Mellitus (T1DM) patients worldwide.1 DN is characterised by the development of albuminuria, hypertension, and reduction in renal function. Early renal structural changes occur as early as eighteen months after diagnosis.2 Urinary albumin-to-creatinine ratio is the current gold standard to test for DN which is usually only detectable after ten years of disease duration. There are 4 main mechanisms resulting in DN which includes inflammatory changes, oxidative stress, tubular injury and glomerular damage. This audit aimed at reviewing diabetic glucose control in the form of HbA1c levels whilst focusing specifically on the incidence of nephropathy and adherence to National and International guidelines. Methods Sixty-nine patients were included in the audit for the time period of 1st January 2022 to 31st December 2022. Their demographics, HbA1C levels, urine albumin-to-creatinine ratios, Body mass index (BMI), blood pressure readings, and number of health checks were recorded. Data was retrospectively entered onto Excel from clinic letters and laboratory records (LabWeb). The data was assessed according to the National DN guidelines and the National Health Service Executive (NICE) guidelines.2 3 Results A total of 69 children were included in this audit. The mean HbA1C was 66.4 mmol/mol (8.2%). 23% (25/69) of the study group had good glycaemic control HbA1c Conclusion Most children 87% (60/69) did not achieve recommended glycaemic control which puts them at higher risk for developing associated microvascular complications.2 Only 6% (4/69) of children had elevated urine albumin to creatinine ratios which resolved on the repeat sampling. Adherence to the latest guidelines is essential for early detection of DN and appropriate intervention. More specific markers like renal tubular markers will be available in the future for earlier detection of DN.4 References Mamilly L, et al. Evidence of early diabetic nephropathy in pediatric type 1 diabetes, sec. Pediatric Endocrinology. Volume 12 – 2021, 28 April 2021. https://doi.org/10.3389/fendo.2021.669954 Diabetes (type 1 and type 2) in children and young people: diagnosis and management NICE Guidelines, NG18 11 may 2023. National clinical guideline: Annual review and co-morbidity screening in Paediatric Type 1 Diabetes Clinical Design and Innovation Health Service Executive, V 1 Developed by: National Clinical Programme for Paediatric Diabetes 2023. C Muntean, et al. Diabetic kidney disease in pediatric patients: acurrent review. World J Diabetes 2022;13(8):587–599. doi:10.4239/wjd.v13.i8.587. PMID: 36159227; PMCID: PMC9412860.