Audit of care of newly diagnosed children with diabetes mellitus in East Anglia.

The aim of this study was to audit the organization of services and management at diagnosis of Type 1 diabetes mellitus (IDDM) in children in the eight districts of East Anglia. Representatives of each district met and agreed indicators of good practice. Service organization was assessed by questionnaire. Provision of care was audited using a proforma completed prospectively for every newly diagnosed child. Outcomes were audited by an anonymous questionnaire to families at the first outpatient appointment to assess satisfaction with care, the education received, and confidence in basic skills needed for home care of diabetes. All districts had a designated paediatric diabetic clinic, all but one led by a paediatrician. All had nurse specialists, but the posts varied widely. Only three units had joint clinics for adolescents. In total, 75% of the families returned the questionnaire. Satisfaction with support by health professionals was high. Education was good for injection technique, blood testing and diet management. Home visits by nurses were variable. Contact with schools and introduction to support groups was poor. Confidence in management was best when there was a dedicated paediatric specialist nurse with adequate cover within the team to allow home and school visits. Following peer review and implementation of an action plan, reaudit was undertaken one year later. Modest improvements were achieved in problem areas; solutions varied in different districts. Collaborative, multi-district audit allows comparison between demographically similar districts. Audit encourages improved practice within existing teams and allows an informed bid for scarce resources.