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Highs and lows of diabetic care: lessons from a national audit
  1. Justin T Warner
  1. Correspondence to Dr Justin T Warner, Noah’s Ark Children’s Hospital for Wales, Heath Park, Cardiff CF14 4XW, UK; justin.warner{at}wales.nhs.uk

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Introduction 

There are approximately 3.5 million people living in the UK who have been diagnosed with type 1 or type 2 diabetes—in England and Wales, approximately 26 500 of these are children and young people under 18 years of age, with >95% suffering from type 1 diabetes. These individuals carry a lifetime risk of serious long-term complications such as cardiovascular disease and increased risk of strokes and/or heart disease, blindness (retinopathy), kidney disease (nephropathy), peripheral vascular disease and neuropathy with increased risk of limb amputations. Current research demonstrates that for a child diagnosed with type 1 diabetes, the expected loss of life expectancy is 10–12 years.1 This risk can be substantially reduced with good diabetes care and careful blood glucose control, thereby reducing the burden of cost to the patient, family and the National Health Service (NHS).

In any clinical service it is essential that the healthcare professionals delivering care strive for excellence and continue to endorse quality improvement (QI) programmes that drive progress. This is particularly poignant for chronic diseases such as diabetes, where outcomes are related to disease control. Measurement of outcomes or processes of care has become a vital part of the QI cycle where it is essential to measure such metrics against accepted standards. The National Paediatric Diabetes Audit (NPDA) for England and Wales has been in existence since 2003 and has provided a comprehensive annual report at the national level, and in recent years also at the regional and hospital levels.2 This allows year-on-year benchmarking of performance and has acted as a powerful tool to drive change which over the last 6 years has demonstrated considerable improvement in care with better outcomes and patient experience. However, there is still considerable variability in outcomes across the two nations and suboptimal results when benchmarked against some of our European counterparts. ‘Resting on our laurels’ is not yet …

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