Too many children with diabetes “not getting the care they need”

That's the headline on the Diabetes UK website today. Ouch.

The headline focusses on children over the age of 12, who should be getting seven key assessments each year:

1. HbA1C (the classic marker for long term complications...)
2. BMI (looking for a healthy weight)
3. Blood Pressure (storing up problems associated with high BP, including heart disease and stroke)
4. Urinary Albumin (early warning of kidney function issues and potential failure later in life)
5. Cholesterol (linked with high BP for cardiovascular events later in life)
6. Eye Screening (early warning sight issues, including blindness)
7. Foot Exam (indicating small blood vessel damage, possibly leading to amputation if not controlled)

The National Paediatric Diabetes Audit, published by the Royal College of Paediatrics and Child Health, found that only 16.1 percent of children aged 12 years and older are getting these seven annual checks. The good news is that it appears the recent progress in reaching the (mainly) T1D paediatric population is continuing, with all seven checks completed in a third more patients than in 2012/13. The less good news is that the year-on-year improvement is slower than in 2011/12 - 12/13, so it's clear there's still a long way to go.

I'm disappointed that uptake is still so low. In this age group these are almost always early warning markers - they're giving patients, their carers and their clinical teams the heads up that action needs to be taken, or at least attempted, to avoid potentially serious healthcare issues later in life. For the T1D child and their parents that's obviously really important. For a cash-strapped NHS these assessments should offer a cheap way of taking preventative action and support to avoid or delay very costly intervention later in the patient's life. And, of course, that cost ripples far beyond the NHS to the overall cost to society, in terms of work and social impact of these complications.

What I'm not clear about is the cause of the low level delivery of the seven assessments? If I was in Diabetes UK, JDRF (or up at the top of NHSE, God help me...), I'd want to know the contribution to the 83.9% shortfall on this target from:

• Assessment commissioning requested but not financed locally
• Assessments not requested locally (lack of support /resource from within clinical teams?)
• Appointments not taken up by PWD (ignorance / lack of support from parents / carers?) 

The report is complemented by the State of the Nation Report.

To end on a positive, I was very pleased to read the BBC's coverage, which highlighted early on in the package that Type 1 does not equal Type 2 Diabetes:

Type 1 diabetes often appears in childhood. It is caused by the immune system destroying cells in the pancreas, leaving patients unable to control their blood sugar. This is different to the far more common type 2 diabetes, which is largely due to an unhealthy lifestyle.

I continually find the T1D label hindering rather than promoting understanding of Janki's additional requirements, symptoms and risks. Working on the assumption that a name change is unlikely, at least some in the media have found time to take a few key strokes to state they are different. Thanks Smitha Mundasad @ BBC.