6484 Compliance of routine screening investigations for children and young people with newly diagnosed type-1 diabetes mellitus (T1DM) in a district general hospital

Objectives To assess compliance rate for screening investigations (HbA1C, Coeliac, Thyroid Function Test – TFTs, and DM autoantibodies) in Newly-diagnosed T1DM in line with Local and National guidelines.1 2 To identify screen-positive results. To identify reasons for missed screening and propose recommendations Methods Retrospective data of newly-diagnosed T1DM patients between April 2021 and April 2023 was obtained from Local Electronic Patient Records (EPR) and Twinkle (National database for diabetes). 12 patients were excluded (9- transferred from another hospital; 1- cystic Fibrosis-related diabetes mellitus; and 2- suspected Type-2 DM). A total of 79 patients were evaluated for this audit and number of screen-positive results were identified. Reasons for missed screening were collated from staff interviews and recommendations proposed. Results Most of our newly-diagnosed patients were boys (51%) with peak 'age at diagnosis' being 5–8 years (24%) and 9–12 years (38%) corresponding to the global statistics for sex and age distribution of T1DM.3 4 Our Overall Compliance rate(defined as having all 4 tests performed and resulted) was 78% and 4% of patients had no screening tests done. There were higher compliance rates for TFTs and Coeliac screens 95% & 90% respectively compared to HbA1C and DM autoantibodies 87% each. Further analysis showed 4 patients (5%) had confirmed coeliac disease and 2 patients (2.5%) had confirmed hypothyroidism. DM autoantibodies (Glutamic acid decarboxylase GAD, Insulinoma-associated protein 2 IA-2, Zinc transporter ZnT8) analysis showed 18 patients were screen-positive for all autoantibodies and 7 patients were screen-negative. More patients had positive IA-2 tests (55%) compared to GAD and ZnT8. These findings correlated with the existing evidence on the prevalence of coeliac, thyroid diseases, and autoantibody sensitivity in T1DM.5 6 Reasons for missed screening were poor staff awareness of screening investigations and sampling-related errors. Proposed recommendations included increasing staff awareness of screening, staff training on sampling techniques, creation of an investigation pre-order set, and its inclusion on the EPR discharge checklist. Conclusion This audit highlighted a low compliance rate for screening investigations and areas for local interventions to improve overall compliance. The presence of screen-positive results for coeliac disease and hypothyroidism buttresses the need to comply with these screening investigations to pick up such cases and improve the general outcome of our patients. References 1 Care of the well child, newly diagnosed with type 1 diabetes mellitus. Association of Children's Diabetes Clinicians 2012. Diabetes (type 1 and type 2) in children and young people: Diagnosis and management: Guidance. NICE 2015. Durruty, P. et al. 'Age at diagnosis and seasonal variation in the onset of insulin-dependent diabetes in Chile (southern hemisphere)', Diabetologia 1979. Hsia, Y. et al. 'An increase in the prevalence of type 1 and 2 diabetes in children and adolescents: Results from prescription data from a UK general practice database', British Journal of Clinical Pharmacology 2009. National Paediatric Diabetes Audit Annual Report 2020–21: Care Processes and Outcomes. London: Royal College of Paediatrics and Child Health 2022. Ross, C. et al. 'The prevalence of islet autoantibodies in children and adolescents with type 1 diabetes mellitus: A global scoping review', Frontiers in Endocrinology 2022.