AUDIT OF DIABETES CARE BY CASELOAD

Objective-To investigate the relationship between clinic provision, co nsultant and nursing caseload, and processes and outcomes of diabetes care in children. Design-Retrospective audit in the South Western regi on of England of 801 children and young people with diabetes; 701 were seen in a designated clinic, Seven of 21 consultants fulfilled the Br itish Paediatric Association (BPA) criteria for a specialist in childh ood diabetes. Seventeen nurses provided specialist care. Main outcome measures-Glycated haemoglobin, admissions to hospital clinic attendanc e rates, contacts with a dietitian, measurements of height and weight, and screening rates for hypertension, microalbuminuria, and retinopat hy. Results-Children under the care of 'nonspecialists' had higher adm ission rates to hospital with all diabetes related problems and for hy poglycaemia and lower screening rates for microalbuminuria than those under 'specialists'. Children under the care of the two tertiary hospi tal consultants had lowest glycated haemoglobin results, spent least t ime in hospital at diagnosis, were most likely to have their heights a nd weights plotted, and to be screened for microalbuminuria and retino pathy, had higher admission rates, lower clinic attendance rates, and fewer dietitian consultations. Higher nursing caseloads were associate d with longer periods of admission at diagnosis, better clinic attenda nce rates, reduced rates of admission after diagnosis, and less likeli hood of having blood pressure measured and being screened for microalb uminuria. Children attending general paediatric clinics were less Like ly to be seen by a dietitian and to have their height and weight plott ed. Conclusions-The results are consistent with the recommendation of a BPA working party in 1990 that children with diabetes should be care d for by specialist paediatricians with a caseload of more than 40 chi ldren, and that children should be seen in a designated diabetic clini c.