Following the rules: which type 1 diabetes guidelines, protocols and recommendations are tertiary clinics in Australia following? A quantitative study
Abstract
OBJECTIVES: This study characterises the use of type 1 diabetes (T1D) guidelines and protocols in Australian T1D clinics working with paediatric patients, and determines if management practices align with T1D-specific guidelines. METHODS: T1D clinic service leaders responded to an online survey on guidelines (e.g. glycated haemoglobin target levels, time in range targets, and technology uptake and management) and protocols (e.g. surgery) used. Responses were compared with T1D guidelines or protocols. RESULTS: A representative healthcare professional from 32 T1D services (16 metropolitan; 16 regional) from all Australian states and territories completed the survey. Most services (90%) reported glycated haemoglobin targets of <7% and a time in range of ≥70% (95%). Twenty-one services (72%) developed shared care plans, giving access to schools (91%), patients/families (81%) and general practitioners (71%), and with referrals to other health professionals (52%). Most (79%) clinics provided patients with International Society for Pediatric and Adolescent Diabetes/National Institute of Clinical Excellence guideline-aligned responses on managing out-of-range blood glucose level readings from T1D-related technologies. Regional clinics (68%) provided guideline-aligned responses less frequently than metropolitan clinics (91%). Services used combinations of state-based, national and locally developed protocols for patient management. CONCLUSIONS: This is the first Australia-wide study examining the protocols and guidelines followed for paediatric T1D management by T1D clinics. Most services reported management practices aligned with T1D guidelines. Greater sharing of care plans when referring patients to other services could improve care continuity. Increasing regional clinics' delivery of guideline-aligned information to patients on using T1D technology could support patient self-management. This survey provides a benchmark of diabetes guideline awareness and protocol usage in Australia.
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Authors: Carolynn L. Smith, Ann Carrigan, Nehal Singh, Timothy W. Jones, Leanne Cromb, Helen J. Woodhead, Anthony Pease, Tony Huynh, Ann M Maguire, Kristen Neville, David E. Bloom, Sophia Zoungas, Jenny Couper, Jeffrey Braithwaite, Elizabeth A. Davis, Yvonne Zurynski
Institutions: The University of Queensland, The University of Sydney, Harvard University, The University of Adelaide, Monash University, Macquarie University, Harvard University Press, The University of Western Australia, Monash Health, The Kids Research Institute Australia, Princess Margaret Hospital for Children, Children's Hospital at Westmead, Women's and Children's Hospital, Diabetes Australia, Alfred Health, Peninsula Health, Sydney Children's Hospital, Center for Children, Australian Institute of Health and Welfare, Human Factors (Norway), General Department of Preventive Medicine, Doctors Medical Center, Dana-Farber/Harvard Cancer Center, Canadian Paediatric Society