6648 Audit of university hospitals Birmingham ‘High HbA1c pathway’ for children and young people with type 1 diabetes mellitus

Objectives The National Institute for Health and Care Excellence recommends maintaining HbA1c <48mmol/mol (<6.5%) in children and young people (CYP) with type 1 diabetes mellitus (T1DM) to minimise complications.¹ Yet, the national average HbA1c in this group is significantly worse, at 64mmol/mol (8%).² The University Hospitals Birmingham (UHB) 'high HbA1c pathway' aims to lower and maintain HbA1c <8.5% in 100% of CYP with a starting HbA1c >8.5%. Spanning 3 months, the pathway involves five appointments, commencing with a nurse-led review, followed by three nurse-led telephone appointments, and concluding with a multi-disciplinary team review. We conducted an audit of the UHB high HbA1c pathway to assess the following: Is the UHB high HbA1c pathway being followed correctly? Is the UHB high HbA1c pathway effectively lowering patients' HbA1c? Methods The audit was set in UHB Paediatric Diabetes Department. Dendrite electronic health records for all CYP with T1DM initiated on the UHB high HbA1c pathway between April 2022 and September 2022 were retrospectively reviewed. Data on patient demographics, attendance rates, and HbA1c measurements were collected. Subsequent quantitative data analysis was conducted using Microsoft Excel. Results 35 CYP were initiated on the pathway between April 2022 and September 2022. Conclusion All CYP initiated on the UHB high HbA1c pathway had a lower HbA1c upon pathway completion. However, only 31% of CYP achieved the target HbA1c of <8.5% upon pathway completion; 64% of them succeeded in maintaining HbA1c <8.5% at 6 months. Furthermore, only 14% of CYP had 100% adherence to the pathway. The reasons for <100% adherence were most commonly administrative errors (failure to recognise which patients were initiated on the pathway, failure to book follow up appointments, failure to reschedule missed appointments), followed by patients missing appointments and a mixture of both. There is insufficient data to identify correlation between pathway adherence and HbA1c because of retrospective data collection, <100% pathway adherence, and small sample size. To improve pathway adherence we recommend the following: Clearly and accurately document patients initiated on the pathway Assess and address missed appointments Ensure prompt rescheduling of missed appointments. Conducting a re-audit of the pathway after implementation of above recommendations could help establish the correlation between pathway adherence and HbA1c. References National Institute for Health and Care Excellence. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. NICEguidelines NG18 [internet]. London: National Institute for Health and Care Excellence; 2015/2022 [cited 2022 Oct 21]. Available from: https://www.nice.org.uk/guidance/ng18 RCPCH State of Child Health. Diabetes [internet]. 2020 [cited 2022 Oct 26]. Available from: https://stateofchildhealth.rcpch.ac.uk/evidence/long-term-conditions/diabetes/