Table 2.
Adherence by indicator
| Recommendation | No. of children |
No. of visits |
Proportion adherent % (95% CI) |
| 1. Children and adolescents with type 1 diabetes, at diagnosis, received investigations for insulin antibodies. | 103 | 127 | 80.3 (64.0 to 91.5) |
| 2. Children and adolescents with type 1 diabetes, at diagnosis, received investigations for GAD antibodies. | 102 | 126 | 81.3 (63.6 to 92.8) |
| 3. Children and adolescents newly diagnosed with type 1 diabetes were screened for celiac disease (total IgA, antigliadin Ab, tissue transglutaminase Ab). | 105 | 136 | 88.4 (76.1 to 95.8) |
| 4. Children and adolescents newly diagnosed with type 1 diabetes were screened for thyroid dysfunction (TSH, fT4). | 106 | 137 | 90.8 (83.5 to 95.6) |
| 5. Children and adolescents diagnosed with type 1 diabetes who presented with suboptimal glycemic control (eg, HbA1c >10% or 86 mmol/mol) were assessed for co-occurrence of psychological disorders using a validated screening tool. | 61 | 128 | 37.9 (11.7 to 70.7) |
| 6. Children and adolescents diagnosed with type 1 diabetes who presented with insulin omission were assessed for co-occurrence of psychological disorders using a validated screening tool. | 24 | 45 | 58.7 (22.4 to 89.0) |
| 7. Children and adolescents diagnosed with type 1 diabetes who presented with disorder eating behaviours were assessed for co-occurrence of psychological disorders using a validated screening tool. | 14 | 19 | Insufficient data |
| 8. Children and adolescents diagnosed with type 1 diabetes who presented with recurrent admissions for DKA were assessed for co-occurrence of psychological disorders using a validated screening tool. | 12 | 22 | Insufficient data |
| 9. Children and adolescents with type 1 diabetes had an intensive glycemic control plan implemented that included MDI or CSII. | 237 | 492 | 98.4 (95.7 to 99.6) |
| 10. Children and adolescents with type 1 diabetes had an intensive glycemic control plan implemented that included frequent insulin dose adjustment. | 237 | 494 | 98.3 (95.5 to 99.6) |
| 11. Children and adolescents with type 1 diabetes had an intensive glycemic control plan implemented that included blood glucose level monitoring at least four times per day. | 237 | 496 | 86.8 (52.8 to 99.2) |
| 12. Children and adolescents with type 1 diabetes had an intensive glycemic control plan implemented that included monitoring of HbA1c at least 4-monthly. | 230 | 482 | 89.2 (79.7 to 95.2) |
| 13. Children and adolescents with type 1 diabetes who presented with signs of DKA had their level of dehydration recorded as mild (<4%), moderate (4%–7%) or severe (>7%). | 138 | 242 | 53.7 (38.7 to 68.2) |
| 14. Children and adolescents with type 1 diabetes who presented with signs of DKA had their vital signs monitored. | 135 | 241 | 100 (98.5 to 100) |
| 15. Children and adolescents with type 1 diabetes who presented with signs of DKA had their level of consciousness assessed using the Glasgow coma scale. | 135 | 240 | 75.7 (64.1 to 85.1) |
| 16. Children and adolescents with type 1 diabetes who presented with signs of DKA had their airway and breathing assessed and maintained. | 135 | 241 | 96.3 (89.1 to 99.3) |
| 17. Children and adolescents with type 1 diabetes who presented with signs of DKA had their blood glucose, urea and electrolytes (sodium, potassium, calcium, magnesium, phosphate) assessed at the time of presentation. | 135 | 228 | 70.2 (54.6 to 83.0) |
| 18. Children and adolescents with type 1 diabetes who presented with signs of DKA had their blood ketones (bedside test) assessed at the time of presentation. | 135 | 229 | 84.4 (71.9 to 92.8) |
| 19. Children and adolescents with type 1 diabetes who presented with signs of DKA had their venous blood gas (including bicarb) assessed at the time of presentation. | 135 | 228 | 87.8 (75.8 to 95.2) |
| 20. Children and adolescents with type 1 diabetes who presented with signs of DKA and tested negative for ketones were managed with subcutaneous insulin. | 26 | 29 | 92.7 (76.7 to 99.0) |
| 21. Children and adolescents with type 1 diabetes who presented with signs of DKA and had a normal pH in the presence of ketones were managed with subcutaneous insulin. | 53 | 80 | 73.6 (38.4 to 94.9) |
| 22. Children and adolescents with type 1 diabetes who presented with signs of DKA and a BGL ≥11.1 mmol/L had blood ketones tested on a capillary sample. | 131 | 226 | 82.4 (73.5 to 89.3) |
| 23. Children and adolescents with type 1 diabetes who presented with severe DKA (blood glucose >11 mmol/L, venous pH <7.1, bicarbonate <5 mmol/L) and hypoperfusion (delayed capillary return, tachycardia for age) received a bolus of 0.9% normal saline (10 mL/kg). | 36 | 50 | 88.8 (67.4 to 98.3) |
| 24. Children and adolescents with type 1 diabetes who presented with severe DKA (blood glucose >11 mmol/L, venous pH <7.1, bicarbonate <5 mmol/L) and hypoperfusion (delayed capillary return, tachycardia for age) received rehydration with normal saline and potassium. | 34 | 50 | 97.5 (88.6 to 99.9) |
| 25. Children and adolescents with type 1 diabetes who presented with severe DKA (blood glucose >11 mmol/L, venous pH <7.1, bicarbonate <5 mmol/L) and hypoperfusion (delayed capillary return, tachycardia for age) had their fluid type adjusted according to ongoing sodium, potassium and glucose levels. | 31 | 47 | 100 (92.5 to 100) |
| 26. Children and adolescents with type 1 diabetes who presented with DKA and a potassium >5.5 mmol/L, or were anuric, had commencement of potassium replacement therapy deferred. | 10 | 12 | Insufficient data |
| 27. Children and adolescents with type 1 diabetes who presented with moderate-to-severe DKA had a repeat serum potassium within 1 hour of insulin being commenced. | 72 | 105 | 71.6 (57.1 to 83.4) |
| 28. Children and adolescents with type 1 diabetes were provided with face-to-face education within 6 weeks of diagnosis by a qualified dietician on accurate carbohydrate counting. | 117 | 176 | 67.7 (21.6 to 96.5) |
| 29. Children and adolescents with type 1 diabetes had a comprehensive sick-day management plan in their medical record that included blood ketone measurement (or urine ketone measurement if blood ketone was not available). | 230 | 454 | 50.8 (25.3 to 76.0) |
| 30. Children and adolescents with type 1 diabetes had a comprehensive sick-day management plan in their medical record that included written guidelines and details on 24 hours access to clinical advice. | 231 | 458 | 56.8 (40.3 to 72.3) |
| 31. Children and adolescents with type 1 diabetes with DKA were referred at presentation for consultation with a local pediatric team. | 124 | 216 | 98.4 (95.6 to 99.6) |
| 32. Children and adolescents with type 1 diabetes with hypernatremia or hyponatremia were referred at presentation for consultation with a local pediatric team. | 48 | 70 | 97.8 (90.8 to 99.8) |
| 33. Children aged <18 months with type 1 diabetes who presented with DKA were transferred to and/or consulted with tertiary care for intensive care monitoring. | 10 | 11 | Insufficient data |
| 34. Children and adolescents with type 1 diabetes who presented with DKA and coma were transferred to and/or consulted with tertiary care for intensive care monitoring. | 2 | 2 | Insufficient data |
| 35. Children and adolescents with type 1 diabetes who presented with DKA and signs of cerebral edema were transferred to and/or consulted with tertiary care for intensive care monitoring. | 6 | 7 | Insufficient data |
Ab, antibodies; BGL, blood glucose level; CSII, continuous subcutaneous insulin infusion; DKA, diabetic ketoacidosis; fT4, free thyroxine (T4); GAD, glutamic acid decarboxylase; HbA1c, hemoglobin A1c; IgA, immunoglobulin A; MDI, multiple daily injections; TSH, thyroid-stimulating hormone.