NPDA 2023-24 Report on Care and Outcomes
Source: data.gov.uk (2025-04-04)

National Paediatric Diabetes Audit 2023 - 2024. The excel file contains unit, regional and national level data obtained from the National Paediatric Diabetes Audit 2023-2024.

Specifically, it includes information on patient characteristics, completion of health checks and outcomes achieved (as recommended by the National Institute for Clinical Excellence) for infants, children and young people with type 1 diabetes, under the age of 25, who attended paediatric diabetes units in England and Wales between 1 April 2023 and the 31 March 2024.

Data are included for the six key health checks: • Glycated Haemoglobin A1c (HbA1c) • Body Mass Index (BMI) • Thyroid • Blood pressure • Urinary albumin • Eye screening.

Data on other health checks include: • Psychological assessment • Offering of immunisation against influenza • Advice about managing diabetes (‘sick-day rules’) • Using (or trained to use) blood ketone testing strips and a meter • Cholesterol • Additional dietetic support

Data are included for health checks at diagnosis • Screening for autoimmune disease (coeliac and thyroid disease) • Provision of Level 3 carbohydrate-counting education

Data on outcomes of care include: • HbA1c target measurements • Small vessel (microvascular) disease • Large vessel (macrovascular) disease • Autoimmune disease (coeliac and thyroid disease)

The data were first published in 2025 alongside the National Paediatric Diabetes Audit Report 2023-2024 Data suppressed due to small numbers (<5).

For further information and details on the audit please refer to: 

• National Paediatric Diabetes Audit Annual Reports: https://www.rcpch.ac.uk/resources/npda-annual-reports
• NPDA Annual Dashboard:
https://www.rcpch.ac.uk/resources/NPDA-dashboard
• RCPCH Website:
https://www.rcpch.ac.uk/work-we-do/clinical-audits/npda

Audits 
RCPCH
NPDA
National Paediatric 
Diabetes Audit
National Paediatric Diabetes 
Audit (NPDA) 2025 Report on 
Care and Outcomes 2023/24
Royal College of 
Paediatrics and Child Health
RCPCH

NPDA
National Paediatric 
Diabetes Audit
Contents
Introduction	
	
	
	
3
Key messages	
	
	
	
4
National recommendations	
	
	
	
5
2023/24 Results Summary	
	
	
	
6
01. How many children and young people were receiving care	 	
	
6 
from paediatric diabetes services in England and Wales?
02. What percentages of children and young people received	 	
	
7 
all six recommended health checks?
03. What percentage of all recommended health checks were	 	
	
8 
delivered by PDUs in 2023/24?
04. What percentages of children and young people with Type 1	
	
8 
diabetes received other recommended checks at diagnosis?
05. Has there been improvement in national HbA1c?	
	
	
	
9
06. What percentages of children and young people with diabetes	
	
10 
were at risk of macrovascular and microvascular complications?
07. What percentages of children and young people with Type 1	
	
11 
were using diabetes-related technologies?
08. What was the average HbA1c for children and young people	
	
11 
with Type 1 diabetes using different diabetes-related technologies?
09. What percentages of children and young people with Type 1	
	
12 
diabetes had diabetes-related hospital admissions?
10. How many children and young people with diabetes were assessed	
13 
as requiring additional psychological support following assessment?
Spotlight on inequalities	
	
	
	
13
Quality improvement resources	
	
	
	
14
Front cover art  
competition winner:
Phoenix S.
© Healthcare Quality Improvement  
Partnership (HQIP)
Cite as: National Paediatric Diabetes Audit 
Annual Report 2023-24: Care Processes and 
Outcomes. RCPCH: London, 2025. 
The Royal College of Paediatrics and Child Health 
is a registered charity in England and Wales 
(1057744) and Scotland (SCO38299)
2

HQIP is led by a consortium of the Academy 
of Medical Royal Colleges, and the Royal 
College of Nursing. Its aim is to promote 
quality improvement in patient outcomes, 
and in particular, to increase the impact that 
clinical audit, outcome review programmes 
and registries have on healthcare quality 
in England and Wales. 
HQIP holds the contract to commission, 
manage, and develop the National Clinical 
Audit and Patient Outcomes Programme 
(NCAPOP), comprising around 40 projects 
covering care provided to people with a wide 
range of medical, surgical and mental health 
conditions. The programme is funded by 
NHS England, the Welsh Government and, 
with some individual projects, other devolved 
administrations and crown dependencies. 
www.hqip.org.uk/national-programmes
The NPDA has been reporting for 20 years. 
Data is submitted by healthcare professionals 
in Paediatric Diabetes Units (PDUs) in England 
and Wales about the care received by the 
children and young people with diabetes 
using their service.
The effectiveness of diabetes care is measured 
against NICE guidelines (NG18, NICE 2015) 
and includes treatment targets, health checks, 
patient education, psychological wellbeing, and 
assessment of diabetes-related complications 
including acute hospital admissions, all of 
which are vital for monitoring and improving 
the long term health and wellbeing of children 
and young people with diabetes. In 2023/24, 
100% of PDUs participated in the NPDA. 
Extended analysis:
Extended analyses of the 2023/24 data, 
PDU level reports and posters, a glossary 
of terms of used in this report, and links to 
Excel files of data at PDU, regional network, 
and integrated care board (ICB) local health 
board (LHB) levels are available within the 
annual reports page:
https://www.rcpch.ac.uk/resources/npda-
annual-reports
Annual summary results are also available 
at PDU, regional network, NHSE region, and 
ICB/LHB levels via NPDA Results Online:
https://npda-results.rcpch.ac.uk
Additionally, quarterly updates on key 
metrics are available at PDU, regional 
network, NHSE region, ICB/LHB, and  
country levels via the NPDA Frequent 
Reporting Dashboard:
https://www.rcpch.ac.uk/resources/NPDA-
dashboard
Further information:
Further information on the background, 
aims, and scope of the NPDA is available at: 
https://www.rcpch.ac.uk/work-we-do/
clinical-audits/npda/about
The National Paediatric Diabetes Audit (NPDA) is managed by the Royal College of Paediatrics 
and Child Health (RCPCH) and commissioned by the Healthcare Quality Improvement Partnership 
(HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).
Introduction
3
National Paediatric Diabetes Audit (NPDA) 2025 Report on Care and Outcomes 2023/24

Key messages 
Despite the incidence of paediatric diabetes 
in 2023/24 returning to near pre-COVID-19 rates, 
the prevalence of children and young people 
(CYP) with diabetes cared for in a PDU 
in England and Wales has increased 
by 16% since 2018/19. In particular, 
the number of CYP with Type 2 
diabetes has increased by 72%.
Overall the completion rate of health checks 
for Type 1 diabetes at all ages remains high. 
92% of all expected health checks were 
completed, but there is considerable variation 
between PDUs ranging from 75% to 100%. 
•	
For Type 1 diabetes: (12 years and over) 
66% received all six essential 
health checks. 
•	
For Type 2 diabetes: 
(12 years and over) 37% 
received all six essential 
health check.
The national (England and Wales combined) 
median HbA1c for children and young 
people with Type 1 diabetes has fallen to 
60.0 mmol/mol. This is a 0.5 mmol/mol decrease 
from 60.5 mmol/mol in 2022/23. National Institute 
for Health and Care Excellence (NICE) guidelines 
recommend that CYP with diabetes should have 
a HbA1c target of 48 mmol/mol or lower. 
•	
The median HbA1c was 60.0 mmol/mol in Wales, 
compared to 60.5 mmol/mol in England. 
•	
The national median HbA1c for children 
and young people with Type 2 diabetes 
has increased to 50.0 mmol/mol, 
from 49.5 mmol/mol in 2022/23. 
•	
Even after accounting for factors 
that influence HbA1c, there 
remained considerable variation 
in this measure by PDU. 
There have been limited 
improvements in the national 
rates of microvascular and 
macrovascular abnormalities 
despite decreases in HbA1c and 
the increased use of technologies.  
94% of CYP with Type 2 diabetes 
had a BMI in the overweight or 
obese range, compared to 42% 
of CYP with Type 1 diabetes.  
The percentage of children and young 
people with Type 1 diabetes using diabetes-
related technologies has increased. Insulin 
pump use has increased to 55% from 45% 
in 2022/23, real time continuous glucose monitor 
(rtCGM) use has increased to 79% from 49% in 
2022/23, and hybrid closed loop system use has 
increased to 36%, from 15% in 2022/23. 
Fewer children and young people 
are using flash glucose monitors or 
modified flash monitors. However, 
inequalities in the uptake of all 
technologies persist.  
The use of advanced technology 
to deliver insulin and monitor 
blood glucose levels is associated 
with a lower HbA1c.  
The rates of post-diagnosis 
hospital admissions in 2023/24 are 
stable and the incidence of DKA 
at diagnosis of Type 1 diabetes also 
remains stable at 26%. 
Inequalities related to ethnicity and deprivation 
remain prevalent: 
•	
The mean HbA1c for Black CYP with Type 1 
diabetes has increased to 71.0 mmol/
mol from 70.0 mmol/mol in 2022/23 and 
remains higher than that seen in their White 
equivalents of 63.0 mmol/mol. 
•	
The average HbA1c gap remains the same 
between the most and least deprived quintiles: 
66.0 and 60.0 mmol/mol respectively 
in 2023/24, compared to 66.8 and  
59.9 mmol/mol in 2022/23. 
•	
The technology usage (rtCGM, 
insulin pumps and Hybrid Closed 
Loop systems) is less prevalent 
amongst ethnic minority 
groups and those living 
in deprived areas. 
0.1
HbA1c
BMI
Blood Pressure
Thyroid Test
Foot Check
Albuminuria
HbA1c – test
HbA1c – test
HbA1c – test
HbA1c – test
4
National Paediatric Diabetes Audit (NPDA) 2025 Report on Care and Outcomes 2023/24

Recommendations
1
PDU workforce numbers should be mapped against the guidelines published by the National 
Children’s and Young People’s Diabetes Network in 2024 (NCYPDN), taking into account the  
16% increase in children and young people with diabetes in their care.
Action by: Integrated Care Boards across England and Local Health Boards across Wales
4
Diabetes services should offer holistic multidisciplinary support, including dietetic input,  
to children and young people with diabetes who are overweight or obese. 
Action by: Integrated Care Boards across England and Local Health Boards across Wales.
2
The variation in outcomes by geography should be investigated and addressed to ensure that  
children and young people with diabetes have equitable access and care for diabetes. Commissioners 
should use NPDA data (three monthly and annual PDU level reports), alongside other trusted data 
sources and peer review programmes, to assess equity of care within and between their regions.
Action by: Integrated Care Boards across England, Local Health Boards across Wales, the NHS England 
Getting It Right First Time (GIRFT) programme, the National Children and Young People’s Diabetes 
Network and the RCPCH.
5
Children and young people with Type 1 diabetes, regardless of ethnicity and social deprivation, 
should have equitable access to diabetes-related technologies. This could include engagement 
with families that may experience inequalities (such as those within the Core20PLUS5 framework) 
and healthcare professionals to better understand the barriers to equitable access. 
Action by: Integrated Care Boards across England, Local Health Boards across Wales, the NHS England 
Getting It Right First Time (GIRFT) programme, the Children and Young People’s Diabetes Network, 
and diabetes charities such as Diabetes UK and Breakthrough T1D and the RCPCH.
3
Studies should be funded to understand the progression from childhood signs of micro- and  
macro-vascular disease to the development of future diabetes complications, and to inform  
preventative interventions. 
Action by: Research funding bodies and diabetes charities such as Diabetes UK and Breakthrough T1D.
6
Hybrid Closed Loop (HCL) systems should be offered to all eligible children in England and Wales  
in line with NICE Technology Appraisal guidance and the implementation plans in England and Wales. 
The NPDA will continue to support the provision of data to inform the NHS England HCL 5-year 
implementation strategy.
Action by: Integrated Care Boards across England and Local Health Boards across Wales the  
NHS England Getting It Right First Time (GIRFT) programme, and the RCPCH.
5
National Paediatric Diabetes Audit (NPDA) 2025 Report on Care and Outcomes 2023/24

1,250
1,300
1,350
1,400
1,450
1,500
1,550
1,600
1,650
1,700
1,750
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
2015/16
2016/17
2017/18
2018/19
2019/20*
2020/21
2021/22
2022/23
2023/24
Number in Wales
Number of children and young people receiving 
care from a Paediatric Diabetes Unit in England 
England and Wales
England
Wales
There were 35,122 children and young people receiving care from PDUs in 2023/24: 33,437 (95.2%) in 
England and 1,685 (5.0%) in Wales (Table 1). There has been a steady increase in this prevalence since 
the pre-COVID-19 pandemic rates in England and Wales, from 30,155 in 2018/19. This represents a 4,967 
(16.5%) increase in the numbers of children and young people cared for by a PDU in England and Wales. 
The incidence of Type 1 diabetes (0-15 years) decreased from 31.1 new cases per 100,000 in 2022/23 to 27.6 
in 2023/24, with 3,233 new cases diagnosed and managed in PDUs in this audit year. This incidence rate 
is close to the levels observed prior to the COVID-19 pandemic. 
Table 1: Number of children and young people by type of diabetes in 2023/24
*Includes cystic fibrosis diabetes, Maturity-onset diabetes of the young (MODY) and “unknown/unspecified” types of diabetes.
2023/24 Results Summary 
How many children and young people were 
receiving care from paediatric diabetes services
in England and Wales?
SECTION 01
0.1
Country
Total number of children and 
young people with diabetes
Type 1 diabetes
Type 2 diabetes
Other rare 
forms
England
33,437
31,190 (93.3%)
1,323 (4.0%)
924 (2.8%)*
Wales
1,685
1,619 (96.1%)
36 (2.1%)
30 (1.8%)*
England and Wales
35,122
32,809 (93.4%)
1,359 (3.9%)
954 (2.7%)*
Figure 1: Total numbers of children and young people receiving care from PDUs in England and Wales, 2015/16 to 2023/24 
*166 out of 173 PDUs submitted information to the 2019/20 audit, artificially lowering numbers reported.
6
National Paediatric Diabetes Audit (NPDA) 2025 Report on Care and Outcomes 2023/24

2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
2019/20 2020/21 2021/22 2022/23 2023/24
Boys
24.8
28.0
24.8
25.9
26.0
25.8
27.0
33.9
34.1
32.3
28.7
Girls
20.8
24.4
20.8
24.4
24.2
23.3
24.3
27.7
31.3
29.8
26.4
All
22.8
26.5
22.8
25.4
25.1
24.6
25.6
30.9
32.7
31.1
27.6
0
5
10
15
20
25
30
35
Incidence per 100,000 general 
population 0-15 years old
Sex and audit year
Figure 2: Incidence of Type 1 diabetes per 100,000 general population 0-15 years old in England and Wales, from 2013/14 to 2023/24. 
In 2019/20, 166 out of 173 PDUs submitted information to the audit. 
There were 1,359 children and young people in England and Wales being cared for in PDUs with Type 2 
diabetes in 2023/24. Of these, there were 292 new cases in 2023/24 – similar to the 268 new cases recorded 
in 2022/23. There has been a steady increase in this prevalence since the COVID-19 pandemic, from 790 in 
2018/19 to 1,359 in 2023/24. This represents an increase of 569 (72%), over the last four years, in the numbers 
of children and young people with Type 2 diabetes cared for by a PDU in England and Wales. 
There were increases in the completion rates for all individual ‘key’ health checks in 2023/24 compared 
to the previous audit year.
66% of those with Type 1 diabetes aged 12 and above received all six ‘key’ annual health checks 
(HbA1c, BMI, blood pressure, thyroid function test, albuminuria screening, and foot checks), compared 
to 63% in 2022/23. 
37% of those with Type 2 diabetes aged 12 and above received all six ‘key’ health checks (HbA1c, BMI, 
blood pressure, cholesterol, albuminuria screening, and foot checks), compared to 36% in 2022/23. 
Eye screening for retinopathy was reduced to biennial frequency from 2020/21 (unless an abnormal 
result was observed in a previous screen) in many NHS Trusts and Health Boards due to changes in 
national retinopathy screening guidance.
73% of those aged 12 years and above who had an abnormal eye screen in 2022/23 and who were also 
captured in the 2023/24 dataset had an eye screen in 2023/24. A similar proportion (75%) of those aged 
12 years and above who had a normal eye screen in 2022/23 and who were also captured in the 2023/24 
dataset also received an eye screen in 2023/24.
What percentages of children and young people 
received all six recommended health checks?  
SECTION 02
HbA1c
BMI
Blood Pressure
Thyroid Test
Foot Check
Albuminuria
7
National Paediatric Diabetes Audit (NPDA) 2025 Report on Care and Outcomes 2023/24

Figure 3: Percentage of children and young people with Type 1 diabetes receiving individual health checks, 2015/16 to 2023/24 
* Health checks completed for children and young people aged 12 or older.
Figure 4: Column chart of health check completion rates for all children and young people with Type 1 diabetes per PDU  
in England and Wales, 2023/24 
*The overall completion rate represents the total number of the ‘key’ annual health checks completed divided by the total that 
should have been provided based on the age of those included in the analysis.
88% received level three carbohydrate counting education within a fortnight of diagnosis, compared to 
85% in 2022/23.
92% received screening for thyroid disease within three months of diagnosis, similarly to 92% in 2022/23. 
87% received screening for coeliac disease within three months of diagnosis, compared to 88% in 2022/23.
In 2023/24 the overall completion rate for ‘key’ annual health checks received by all children and young 
people with Type 1 diabetes was 92%*, although completion rates varied from 75% to 100% (Figure 4). 
In 2022/23, the overall completion rate for all children and young people with Type 1 diabetes was 91%.
What percentage of all recommended health 
checks were delivered by PDUs?
SECTION 03
What percentages of children and young people with 
Type 1 diabetes received other recommended health 
checks at diagnosis?
SECTION 04
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2015/16
2016/17
2017/18
2018/19
2019/20
2020/21
2021/22
2022/23
2023/24
% of children and young 
people with Type 1 
diabetes who completed 
a full year of care
HbA1c
Blood pressure*
BMI
Urinary albumin*
Foot Exam*
Thyroid
Health check completion rate
PDUs
England
Wales
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100% England & Wales (2023/24)
8
National Paediatric Diabetes Audit (NPDA) 2025 Report on Care and Outcomes 2023/24

The national median HbA1c for children and young people with Type 1 diabetes in  
England and Wales was 60.0 mmol/mol (60.5 mmol/mol for England and 60.0 mmol/mol  
for Wales) in 2023/24. This represents an overall reduction of 0.5 mmol/mol from 60.5 mmol/mol  
in 2022/23. The median HbA1c at PDU level ranged from 55.0 mmol/mol to 70.5 mmol/mol. 
The national median HbA1c for Type 2 diabetes was 50.0 mmol/mol, from 49.5 mmol/mol in 2022/23. 
Has there been an improvement in national HbA1c?
SECTION 05
HbA1c – test
HbA1c – test
Figure 5: Median HbA1c for children and young people with Type 1 diabetes in England and Wales, 2010/11 to 2023/24 
Figure 6: Funnel plot of mean adjusted HbA1c by PDU for those with Type 1 diabetes, 2023/24 
†Characteristics such as age, duration of diabetes, sex, ethnicity and level of deprivation were utilised in a regression model to 
adjust HbA1c to take into account different case mixes between PDUs.
Figure 6 shows considerable variation in mean HbA1c for Type 1 diabetes at PDU level after case mix 
adjustment†. The national HbA1c mean after adjustment was 63.5 mmol/mol.
Variation was also seen in the median HbA1c recorded amongst children and young people with Type 1 
diabetes across Integrated Care Boards in England and Local Health Boards in Wales, ranging from 55.5 
to 63.5 mmol/mol. 
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 2023/24
England
71.6
70.5
69.0
69.0
66.5
65.0
64.0
64.0
62.0
62.0
61.0
61.0
60.5
60.5
Wales
70.5
70.0
70.0
69.0
68.3
65.0
64.0
65.0
62.0
62.0
62.0
62.0
61.0
60.0
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
Median HbA1c (mmol/mol) 
children and young people with 
Type 1 diabetes  
England
Wales
National median 2023/24
50
55
60
65
70
75
80
0
50
100
150
200
250
300
350
400
450
500
Mean adjusted HbA1c (mmol/mol)
Number of children and young people with Type 1 diabetes
PDUs in England
PDUs in Wales
95% level (2 SD)
99% level (3 SD)
Mean (England and Wales)
9
National Paediatric Diabetes Audit (NPDA) 2025 Report on Care and Outcomes 2023/24

What percentages of children and young people 
with diabetes were at risk of macrovascular and 
microvascular complications? 
SECTION 06
Figure 7 compares the distributions of body mass index for children and young people with Type 1 and 
Type 2 diabetes in 2023/24. The body mass index distributions for NPDA data from 2019/20 are shown for 
comparison, along with the 1990 UK reference population.
TYPE 1 DIABETES
TYPE 2 DIABETES
28% (aged 12 and above) had a diastolic or 
systolic blood pressure in the hypertensive 
range (>98th centile after correction for age 
and gender), compared to 30% in 2022/23.
46% (all ages) had a diastolic or systolic 
blood pressure in the hypertensive range 
(>98th centile after correction for age and 
gender), compared to 47% in 2022/23.
19% (aged 12 and above) had a total blood 
cholesterol of 5mmol/l or higher, compared  
to 20% in 2022/23. 
(Cholesterol is no longer included in the health checks specified 
for Type 1 diabetes by NICE, however the NPDA continues to report 
the outcomes of the cholesterol tests undertaken and submitted 
as some PDUs consider it to merit continuing scrutiny). 
32% (all ages) had a total blood cholesterol 
of 5mmol/l or higher, compared to 30% in 
2022/23.
42% (all ages) were overweight or obese 
(BMI>85th centile after correction for age 
and gender), similarly to 42% in 2022/23.
94% (all ages) were overweight or obese 
(BMI >85th centile after correction for age 
and gender), similarly to 94% in 2022/23.
11% (aged 12  and above) had an abnormal 
retinopathy screen, similarly to 11% in 2022/23.
7% (aged 12 and above) had an abnormal 
retinopathy screen, compared to 6% in 2022/23.
10% (aged 12 years and above) had micro- or 
macro- albuminuria, similarly to 10% in 2022/23.
21% (all ages) had micro- or macro-
albuminuria, similarly to 21% in 2022/23.
Table 2: Percentages of children and young people with Type 1 and Type 2 diabetes with evidence of risk factors for micro- and 
macro-vascular complications, 2023/24
Figure 7: Distributions of body mass index of children and young people with Type 1 and Type 2 diabetes in 2023/24 and 2019/20. 
The 1990 UK reference population is shown for comparison.
1st
5th10th
25th
50th
75th 85th
95th
99th
Centiles
UK1990 reference
2019/20 Type 1
2023/24 Type 1
2019/20 Type 2
2023/24 Type 2
10
National Paediatric Diabetes Audit (NPDA) 2025 Report on Care and Outcomes 2023/24

What percentages of children and 
young people with Type 1 were using 
diabetes-related technologies?
SECTION 07
What was the average HbA1c for children 
and young people with Type 1 diabetes 
using different diabetes-related technologies?
SECTION 08
HbA1c – test
HbA1c – test
Across England and Wales:
55% were using an insulin pump, compared to 45% in 2022/23. 
36% were using a hybrid closed loop system, compared to 15% in 2022/23.
79% were using a real time continuous glucose monitor (rtCGM); either combined with 
insulin injections or a pump, compared to 49% in 2022/23.
15% were using a flash glucose monitor or a modified flash monitor, compared to 37% in 
2022/23, as CYP are moving towards more advanced methods of glucose monitoring.
Figure 8 shows the mean HbA1c for CYP with Type 1 diabetes on each treatment regimen, from least 
advanced (insulin injections) to most advanced technologies (HCL), left to right.
Although all treatment regimen types show an increase in mean HbA1c between 2021/22 and 2023/24, 
the increasing adoption of more advanced treatment regimens continues to drive an overall reduction 
in national mean HbA1c over the same period. 
CYP using a hybrid closed loop system had the lowest mean HbA1c at 59.1 mmol/mol. Between 2021/22 
and 2023/24, the number of CYP using HCLs has increased from 2,232 to 11,635, whereas the number 
using insulin injections alone fell from 4,985 to 1,455. 
Table 3: Percentages and numbers of children and young people with Type 1 diabetes using each technology.
*Denominator = the number of children and young people with Type 1 diabetes with a valid recorded treatment regimen.
**Proportion of all children and young people with Type 1 diabetes
Country
Insulin pump*
Hybrid closed loop 
system**
rtCGM*
Flash glucose monitor or 
modified flash monitor*
England
55%  
(16,414/30,002)
36%  
(11,136/31,190)
79%  
(23,022/29,223)
15%  
(4,282/29,223)
Wales
58%  
(913/1,583)
35%  
(562/1,619)
77%  
(1,209/1,562)
17%  
(273/1,562)
England and Wales
55%  
(17,327/31,585)
36%  
(11,698/32,809) 
79%  
(24,231/30,785)
15%  
(4,555/30,785)
11
National Paediatric Diabetes Audit (NPDA) 2025 Report on Care and Outcomes 2023/24

What percentages of children and young people 
with Type 1 diabetes had diabetes-related 
hospital admissions?
SECTION 09
Figure 9: Percentages and numbers of children and young people with Type 1 diabetes admitted at least once for a diabetes-
related cause not associated with diagnosis, 2022/23 and 2023/24
26% of children and young people newly diagnosed with Type 1 diabetes presented with DKA at 
diagnosis in 2023/24 compared to 23% in 2022/23.
There was variation in usage of hybrid closed loop systems by children and young people with Type 1 diabetes 
across Integrated Care Boards in England and Local Health Boards in Wales, ranging from 1% to 70%.
Figure 8: Mean HbA1c for children and young people with Type 1 diabetes using different combinations of treatment regimen and 
glucose monitoring in 2021/22 - 2023/24. Circle size represents the number of children and young people. 
DKA 
(not at diagnosis)
Ketosis 
without acidosis
Hypoglycaemia
Stabilisation
2022/23
2.2%
0.9%
0.6%
2.0%
2023/24
2.1%
0.8%
0.7%
1.9%
Number of children 2022/23 
(Denominator: 31,037)
673
271
180
636
Number of children 2023/24 
(Denominator: 31,026)
667
236
203
595
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
% of those with Type 1 
diabetes admitted at 
least once
Mean HbA1c (mmol/mol)
68.6
66.1
64.0
62.7
57.3
58.9
66.6
70.7
67.0
62.0
62.3
56.8
58.8
64.7
73.0
68.8
66.4
64.1
59.1
National mean
Total number
2021/22: 4,985 
2022/23: 2,904 
2023/24: 1,455
2021 
/22
2022 
/23
2023 
/24
2021 
/22
2022 
/23
2023 
/24
2021 
/22
2022 
/23
2023 
/24
2021 
/22
2022 
/23
2023 
/24
2021 
/22
2022 
/23
2023 
/24
2021 
/22
2022 
/23
2023 
/24
2021 
/22
2022 
/23
2023 
/24
70
65
60
55
50
Total number
2021/22: 7,593 
2022/23: 6,848 
2023/24: 3,130
Total number
2021/22: 2,463 
2022/23: 4,532 
2023/24: 8,200
Total number
2021/22: 1,390 
2022/23: 673 
2023/24: 253
Total number
2021/22: 3,719 
2022/23: 2,985 
2023/24: 843
Total number
2021/22: 3,540 
2022/23: 4,789 
2023/24: 4,234
Total number
2021/22: 2,232 
2022/23: 4,690 
2023/24: 11,635
61.7
66.8
Injections  
& Flash
Pump
Pump  
& CGM
Hybrid closed 
loop system
Injections  
& CGM
Pump  
& Flash
Injections
12
National Paediatric Diabetes Audit (NPDA) 2025 Report on Care and Outcomes 2023/24

How many children and young people with 
diabetes were assessed as requiring additional 
psychological support following assessment?
SECTION 10
NPDA results have shown persistent inequalities in HbA1c outcomes and use of diabetes-related 
technologies associated with ethnicity, deprivation, age, and sex. Presented here are four examples 
– the extended analysis is presented separately and can be viewed and downloaded from the 
NPDA annual reports page.
28% of those with Type 1 diabetes and known outcome of psychological assessment (n=21,327) were 
assessed as requiring additional psychological support outside of multidisciplinary team meetings 
compared to 32% in 2022/23.
39% of those with Type 2 diabetes and known outcome of psychological assessment (n=614) were 
assessed as requiring additional psychological support outside of multidisciplinary team meetings 
compared to 41% in 2022/23. 
Spotlight on inequalities
Figure 10: Mean HbA1c by ethnic group for children and young people with Type 1 diabetes, 2013/14 – 2023/24. 
In 2019/20, 166 out of 173 PDUs submitted information to the audit.
Figure 11: Mean HbA1c by deprivation quintile for children and young people with Type 1 diabetes, 2013/14 – 2023/24. 
In 2019/20, 166 out of 173 PDUs submitted information to the audit.
2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
2019/20 2020/21
2021/22 2022/23 2023/24
White
70.5
69.9
67.7
66.7
67.0
64.6
64.6
63.9
63.4
63.1
63.1
Asian
72.5
72.2
69.3
68.7
68.8
66.2
65.8
65.2
65.0
64.2
63.9
Black
78.0
77.8
74.0
74.2
74.9
71.4
71.9
70.9
70.7
69.9
70.8
Mixed
73.7
73.3
70.6
68.7
69.6
67.5
67.4
67.2
66.4
66.1
65.7
Other
72.1
72.3
69.6
68.2
67.0
63.7
63.0
63.3
62.7
62.9
63.6
55
60
65
70
75
80
Mean HbA1c
(mmol/mol)
2013/14
2014/15
2015/16
2016/17
2017/18
2018/19 2019/20 2020/21 2021/22 2022/23 2023/24
Most deprived
74.7
73.7
71.6
70.7
70.9
68.2
68.3
67.8
67.6
66.8
66.6
Second most deprived
74.0
72.3
69.6
68.7
68.7
66.2
66.1
65.2
65.1
65.0
65.2
Third least deprived
72.2
70.6
68.1
67.0
67.5
65.0
65.1
64.4
63.3
63.0
63.2
Second least deprived
70.4
69.0
66.7
65.6
65.9
63.4
62.7
62.3
61.8
61.8
61.8
Least deprived
69.0
67.2
64.8
64.0
64.2
61.9
62.0
60.7
60.1
59.9
60.0
55
60
65
70
75
80
Mean HbA1c
(mmol/mol)
13
National Paediatric Diabetes Audit (NPDA) 2025 Report on Care and Outcomes 2023/24

Figure 12: Use of rtCGM by ethnic category and deprivation quintile amongst children and young people with Type 1 diabetes: 
2019/20- 2023/24. In 2019/20, 166 out of 173 PDUs submitted information to the audit.
Figure 13: Use of hybrid closed loop systems by ethnic category and deprivation quintile amongst children and young people with 
Type 1 diabetes: 2021/22- 2023/24. In 2019/20, 166 out of 173 PDUs submitted information to the audit.
The RCPCH Diabetes Quality Improvement Website provides multidisciplinary teams with the tools 
to identify, design and analyse their own interventions specific to the needs of the children and young 
people and their families that they care for.
A slide deck is available on the NPDA reports page for teams to customise with their own results, with 
prompts for team discussions around results, and links to relevant QI resources.
The Getting It Right First Time (GIRFT) programme has provided resources for paediatric diabetes units 
as part of their national review of services for children and young adults living with diabetes in England.
Quality Improvement resources
White
Mixed
Other
Asian
Black
Most
Second
most
Third
least
Second
least
Least
Ethnicity
Deprivation
2019/20
20.2%
18.5%
16.0%
15.1%
11.7%
14.0%
17.3%
19.3%
22.3%
25.2%
2020/21
28.4%
29.3%
28.1%
25.3%
21.9%
23.8%
24.9%
27.8%
29.8%
34.7%
2021/22
30.8%
31.3%
26.9%
25.4%
22.2%
23.9%
25.7%
31.1%
32.7%
37.7%
2022/23
50.2%
47.0%
42.7%
42.8%
36.2%
43.3%
45.3%
49.0%
52.1%
54.4%
2023/24
79.8%
77.9%
75.4%
76.7%
67.6%
75.3%
76.9%
78.5%
81.2%
82.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% children and young people with 
Type 1 diabetes using rtCGM
England & Wales (2023/24)
White
Mixed
Other
Asian
Black
Most
Second
most
Third
least
Second
least
Least
Ethnicity
Deprivation
2021/22
7.9%
7.4%
5.9%
5.5%
5.8%
5.7%
6.0%
7.4%
8.8%
9.7%
2022/23
15.5%
15.0%
13.0%
11.6%
10.5%
11.8%
12.6%
15.3%
16.8%
18.0%
2023/24
37.4%
33.8%
32.0%
31.4%
25.4%
32.5%
32.8%
36.3%
38.7%
39.0%
0%
10%
20%
30%
40%
50%
60%
% of children and young people 
with Type 1 diabetes using 
hybrid closed loop systems  
England & Wales (2023/24)
14
National Paediatric Diabetes Audit (NPDA) 2025 Report on Care and Outcomes 2023/24

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and Child Health 
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The Royal College of Paediatrics and Child Health (RCPCH) is a registered charity in England and Wales (1057744)  
and in Scotland (SC038299). 
Royal College of 
Paediatrics and Child Health
RCPCH
National Paediatric Diabetes Audit (NPDA)  
Report on Care and outcomes 2023/24
Healthcare Quality  
Improvement Partnership (HQIP) 
128 City Road  
London, EC1V 2NX
©2025 Healthcare Quality Improvement Partnership.  
Published by RCPCH March 2025