A 2014 audit of Sheffield Teaching Hospital NHS Foundation
Trust found that glycaemic outcomes for type 1 diabetes
(T1DM) patients were sub-standard and potentially damaging.
Even at one-year post-diagnosis, only 23% of patients were
achieving the NICE target of <58mmol/mol vs 27% for all
durations of T1DM in the 2012 National Diabetes Audit. The
existing patient care pathway was reviewed, and a consensus exercise undertaken to
develop a clear evidence-based protocol. Results show significant improvements in
glycaemic control compared with those diagnosed 2012-2013, and there is a more than two-fold increase in
the proportion of patients achieving the NICE target. Staff and patient feedback has been highly positive, with
expectations of staff often exceeded, and 85% of patients being on the recommended insulin regimen.
Sheffield T1DM patients were found to be at increased risk of complications compared to the national average
– therefore the Trust's service was not as effective as it ought to be. Good glycaemic control is the cornerstone
of T1DM management, in order to reduce devastating microvascular complications of diabetes, as shown by the
Diabetes Control and Complications Trial (DCCT). Results from the EDIC study (a follow-up of DCCT) showed that
there is a legacy effect, ie good control from diagnosis is beneficial, even if control in later years is poorer.
To reduce the mean 12-month HbA1c of newly diagnosed T1DM patients, by establishing a clear and
consistent pathway which could be implemented across the two acute hospitals within the Trust.
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