Screening for complications and associated conditions in children with Type 1 Diabetes is routinely performed in Diabetes clinics. Though there are NICE recommendations screening tests, interpretation and management is varied as there is no strong evidence base in paediatrics. We conducted a survey across diabetes units to establish the prevailing practice.
Method Survey monkey questionnaire was sent out to clinicians who care for children with diabetes in England and Wales. We received 85 responses in total with 77 complete responses.
Results 60% of respondents start screening at12 years of age. 28% start screening from diagnosis irrespective of the age.
Microalbuminuria screening is varied across the regions. Majority (60%) use random urine sample 32% use early morning sample for initial testing. Few centres also do timed overnight testing. If the microalbuminuria is positive in the initial sample, majority recheck with early morning sample 67%. About 10% refer to nephrologists, with few centres (4%) starting medical management. ACE inhibitors are the most preferred treatment with some centres using AR blockers. One tertiary centre also considers renal biopsy.
Coeliac Screening is performed annually in 70%, every three years in 14% and only if symptomatic in others. Thyroid screening is performed annually in 96%. Only 76% of respondents perform annual lipid profile. Diet and Glycemic control is recommended in about 80% of units and about 25% of respondents use lipid lowering agents.
77% units perform the same screening tests for both type 1 and Type 2 diabetes.
Conclusion Our survey demonstrates that the practice of screening is widely varied across the regions and even within the same regional network. There is need to develop evidence based and practical national guideline to standardise practice across the networks which will help identify complications early, initiate appropriate treatment and save resources by minimising unnecessary investigations and referrals.
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