Readmission Rates of Children with Type 1 Diabetes Mellitus

The Paediatric Endocrinology Service cares for children with hormone related concerns or conditions, for example disorders of metabolism, thyroid disorders, abnormal puberty, abnormal growth, drenal and pituitary insufficiency, metabolic bone disease etc. Our paediatric endocrinologists will care for your child in a setting that is age-appropriate, along with nurses, educators and nutritionists who are attuned to their special needs.

Persons with type 1 diabetes produce little to no insulin, and require insulin replacement therapy which is delivered by self-injections of insulin several times a day or through continuous insulin infusion using insulin pumps, with or without glucose sensors. Insulin treatment is not only life-sustaining but prevents blood glucose from rising above the desired ranges, thereby reducing the risk of developing long-term diabetes-related complications such as blindness, kidney failure, limb amputations, heart attacks and stroke.

Diabetes centres worldwide monitor glycaemic control of their patients regularly using a blood test called HbA1c, which is an indicator of blood glucose levels over a period of 2 to 3 months prior to the blood test. A patient with lower HbA1c has better glycaemic control than another patient with higher HbA1c. At the same time, a patient’s risk of developing any long-term diabetes-related complication would be low if HbA1c is consistently maintained below 7%. Within a year, a patient will typically have 4 or more HbA1c measurements, from which a yearly mean HbA1c for the individual can be derived.

In line with good clinical practice worldwide, KKH Paediatric Diabetes Service reports yearly clinic mean HbA1c, which is the average of each patient’s yearly mean HbA1c; hence, it is a collective measure of glycaemic control for all the children and young people with type 1 diabetes who are on active follow-up in KKH for a particular year.

The table shows the number of active patients in KKH Paediatric Diabetes Service and the corresponding clinic mean HbA1c in each of the most recent six years from 2019 to 2024. It has been progressively lower, dropping from 8.6% in 2019 to 8.2% in 2024, and approaching the respective benchmarks of 7.8% recorded in 2020 among the paediatric diabetes centres in the international SWEET study group and of 8.1% recorded in 2023 among Asian children and young people with type 1 diabetes in the UK National Paediatric Diabetes Audit which includes most of the paediatric diabetes centres in England and Wales.

In recent years, there has been steady improvement in the overall glycaemic control among patients who were cared for in KKH Paediatric Diabetes service. There remains a gap to achieving the recommended HbA1c of 7% for patients in advanced economies who do have universal access to diabetes care that is assisted by modern technologies such as continuous glucose monitoring devices and automated insulin delivery systems. There is also a need for improving the glycaemic control among specific target patient groups such as patients with less privileged social circumstances.

References:

SWEET Study Group 20202)
National Paediatric Diabetes Audit Annual Report 2023
(Asian Type 1)