NPDA 2021-22 Annual Report
Source: data.gov.uk (2024-05-31)

National Paediatric Diabetes Audit 2021 - 2022. The excel file contains unit, regional and national level data obtained from the National Paediatric Diabetes Audit 2021-2022.
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 2021 and the 31 March 2022.
Data are included for the seven key health checks:
• Glycated Haemoglobin A1c (HbA1c)
• Body Mass Index (BMI)
• Thyroid
• Blood pressure
• Urinary albumin
• Foot examination
• 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 2023 alongside the National Paediatric Diabetes Audit Report 2021-2022 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 results online: http://npda-results.rcpch.ac.uk/default.aspx
• The RCPCH website: https://www.rcpch.ac.uk/npda

National Paediatric Diabetes Audit Report on Care and outcomes 2021/22 
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Contents
Introduction 
Key messages 
National recommendations 
How many children and young people were receiving care from paediatric diabetes services in 
England and Wales in 2021/22? 
What percentages of children and young people received all six recommended health checks 
in 2021/22?   
What percentage of all recommended health checks were delivered by PDUs in 2021/22? 
What percentages of children and young people with Type 1 diabetes received recommended 
checks at diagnosis in 2021/22? 
Has there been longitudinal improvement in national HbA1c? 
What percentages of children and young people with diabetes were at risk of macrovascular 
and microvascular complications in 2021/22? 
What percentages of children and young people with Type 1 diabetes were using diabetes-related 
technologies in 2021/22? 
What was the average HbA1c for children and young people with Type 1 diabetes using 
different diabetes-related technologies in 2021/22? 
What percentages of children and young people with Type 1 diabetes had diabetes-related 
hospital admissions in in 2021/22? 
How many children and young people with diabetes were assessed as requiring additional 
psychological support following assessment in 2021/22? 
Spotlight on inequalities 
Patient story: Using a closed loop system 
Quality improvement resources 
Citation: National Paediatric Diabetes Audit Annual Report 2021-22: Care Processes and Outcomes. 
London: Royal College of Paediatrics and Child Health, 2023. 
© Healthcare Quality Improvement Partnership 2023 
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FRONT COVER ART COMPETITION 
Cover image Winner: Erin K 

National Paediatric Diabetes Audit Report on Care and outcomes 2021/22 
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Introduction 
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). HQIP is led by a consortium 
of the Academy of Medical Royal Colleges, the Royal College of Nursing, and National Voices. 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 19 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 2021/22, 100% of paediatric diabetes teams participated in the NPDA. 
Further information on the background, aims, and scope of the NPDA is available at: 
https://www.rcpch.ac.uk/work-we-do/quality-improvement-patient-safety/national-paediatric-diabetes-
audit/about-national-paediatric-diabetes-audit  
Expanded analysis of 2021/22 data, PDU level reports and posters, a glossary of terms used in this report, 
a line of sight table describing the evidence base for the recommendations made in this report, and links 
to Excel files of data at PDU, regional network and integrated care system level are available within our 
annual reports page: 
https://www.rcpch.ac.uk/resources/npda-annual-reports 
PDU level, regional, local health board and ICS level data is available at: https://npda-results.rcpch.ac.uk/ 
Key messages 
•
The increase in incidence of Type 1 diabetes observed in the first year of the COVID-19 pandemic has
been followed by a continuing increase in the numbers newly diagnosed with the condition in
2021/22. There were 3,883 new diagnoses of Type 1 diabetes in 2021/22 managed within a PDU,
compared to 3,662 in 2020/21. This is 1,010 more than the average number newly diagnosed and being
managed in a PDU between 2013/14-2019/20, before the start of the pandemic. This increase in the
numbers newly diagnosed since 2020, based on the pre-pandemic average, is the same as the
caseload of five averagely sized PDUs.
•
There has been continuing improvement in national median HbA1c. There has also been an increase
in the  use of diabetes technologies associated with lower HbA1c. Use of a closed loop system was
associated with the best HbA1c outcomes.
•
Almost all (98.2%) of those with Type 2 diabetes were overweight or obese, and almost half (46.1%) had
a diastolic or systolic blood pressure in the hypertensive range. Two fifths (42.3%) of those with Type 1

National Paediatric Diabetes Audit Report on Care and outcomes 2021/22 
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diabetes were also overweight or obese, with a third (29.9%) having a diastolic or systolic blood 
pressure in the hypertensive range.  
•
Despite reductions in the percentages recorded as requiring additional support between 2020/21 and
2021/22, over a third of children and young people were assessed as requiring additional psychological
support outside of multidisciplinary team meetings (39.0% of those with Type 1 diabetes and 48.3% of
those with Type 2 diabetes).
•
Inequalities persist in terms of the use of diabetes-related technologies by ethnic group and
deprivation quintile, with a fifth (22.2%) of those with Type 1 diabetes and Black ethnicity using a
rtCGM, (a technology associated with lower HbA1c whether used in combination with injections or a
pump) compared to almost a third of those of Mixed (31.3%) or White (30.8%) ethnicity. However, the
usage gap between White and Black children and between the most and least deprived quintiles has
reduced markedly since 2019/20, when the usage rate of rtCGMs was half that of White children
amongst Black children and young people with Type 1 diabetes.
National recommendations 
1.
Commissioners should ensure adequate staffing of full multidisciplinary diabetes teams to
manage the increasing numbers of cases of Type 1 and Type 2 diabetes observed since 2020,
who are trained to facilitate the optimal use of new diabetes-related technologies.
Action by: Integrated Care Boards across England and Health Boards and Regional Partnership
Boards across Wales.
2.
Children and young people with Type 1 diabetes should have equitable access to diabetes care,
irrespective of social deprivation, ethnicity or geography.  They should be offered a choice of
diabetes technology that is appropriate for their individual needs with families being made
aware of the potential differences in outcome with different modalities of insulin delivery and
blood glucose monitoring.
Action by: Integrated Care Boards across England in line with the aims for diabetes care set out
within Core20PLUS5 – the national NHS England approach to reducing health inequalities for
children and young people. Health Boards and Regional Partnership Boards across NHS Wales and
Public Health Wales.  The RCPCH, to provide a better understanding of ethnic and social deprivation
variability.
3.
Health checks for children and young people with diabetes are essential for early recognition
of complications.  The need for tests and the results should be clearly communicated to families
as part of their individual care package, and completion rates of checks should be monitored
through the year.
Action by: Clinical teams within Paediatric Diabetes Units in NHS Health Boards and Trusts across
England and Wales.
4.
Awareness of diabetes symptomatology amongst the public should be enhanced to avoid
newly diagnosed children and young people presenting with Diabetic ketoacidosis (DKA).
Action by: The Office for Health Improvement and Disparities, NHS England, Public Health Wales
and NHS Wales supported by the National Children and Young People's (CYP) Diabetes Network,
and diabetes charities (Diabetes UK and JDRF).
5.
Studies should be funded to derive evidence for interventions supporting pre-diabetic children
young people to avoid progression to Type 2 diabetes.
Action by: Funding bodies such as the National Institute for Health and Care Research, Diabetes UK.

National Paediatric Diabetes Audit Report on Care and outcomes 2021/22 
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2021/22 Results Summary
There were 33,251 children and young people receiving care from a PDU in 2021/22: 31,685 (95.3%) 
in England and 1,566 (4.7%) in Wales. 
Country 
Total number of children and 
young people with diabetes 
Type 1 diabetes 
Type 2 diabetes 
Other rare forms 
England 
31,685 
29,838 (94.2%) 
1,116 (3.5%) 
731 (2.3%) * 
Wales 
1,566 
1,511 (96.5%) 
28 (1.8%) 
27 (1.7%) * 
England and Wales 
33,251 
31,349 (94.3%) 
1,144 (3.4%) 
758 (2.3%) * 
*Includes cystic fibrosis diabetes, Maturity-onset diabetes of the young (MODY) and “unknown/unspecified” types of diabetes. 
Incidence of Type 1 diabetes (0-15 years) increased from 25.7 new cases per 100,000 in 2019/20 to 
30.9 in 2020/21 and 32.7 in 2021/22, with 3883 new cases diagnosed and managed in PDUs in 2021/22. 
This represents an excess of 789 and 1001 new cases in 2020/21 and 2021/22 respectively compared to the 
average from previous years. This increase in the numbers newly diagnosed since 2020, based on the 
pre-pandemic average, is the same as the caseload of five averagely sized PDUs. 
Figure 1: Incidence of Type 1 diabetes per 100,000 general population 0-15 years old in England and Wales, from 2013/14 to 
2021/22 
There were 281 children and young people newly diagnosed with Type 2 diabetes in 2021/22 – an 
increase from 230 in 2020/21.  
2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
2019/20
2020/21
2021/22
Boys
24.8
28.0
24.8
25.9
26.0
25.8
27.0
33.9
34.1
Girls
20.8
24.4
20.8
24.4
24.2
23.3
24.3
27.7
31.3
All
22.8
26.5
22.8
25.4
25.1
24.6
25.7
30.9
32.7
0
5
10
15
20
25
30
35
40
Incidence per 100,000 
general population 
0-15 years old
Sex and audit year
Boys
Girls
All

 
National Paediatric Diabetes Audit Report on Care and outcomes 2021/22 
 
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59.7% of those with Type 1 diabetes aged 12 and above received all six ‘key’ health checks (HbA1c, BMI, 
blood pressure, thyroid test, albuminuria screening, and foot checks), compared to 40.2% in 2020/21).  
33.0% 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 24.1% in 2020/21.  
 
Figure 2: Percentage of children and young people with Type 1 diabetes receiving individual health checks, 2015/16 to 2021/22 
 
 
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2015/16
2016/17
2017/18
2018/19
2019/20
2020/21
2021/22
% of children and young people 
who completed a full year of care
HbA1c
Blood pressure*
BMI
Urinary albumin*
Eye screen*
Foot Exam*
Thyroid
*  health checks completed for children and young people aged 12 or older.
N.B. Eye screening was reduced to biennial frequency in many NHS Trusts from 2020/21 and has been excluded from compound ‘key
annual check’ reporting by the NPDA since. 

 
National Paediatric Diabetes Audit Report on Care and outcomes 2021/22 
 
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In 2021/22 the overall completion rate (the total number of the six key health checks actually completed 
divided by the total that should have been provided), for key health checks received by children and 
young people aged 12 and above with Type 1 diabetes was 87.2% (up from 70.2% in 2020/21), although 
completion rates varied between PDUs: 
 
 
 
 
 
 
Figure 3: Funnel plot of health check completion rates by PDU for those aged 12 and above with Type 1 diabetes 
 
 
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
0
50
100
150
200
250
300
350
Health check completion rate
Number of young people with Type 1 diabetes aged 12 and above 
who completed a full year of care 2021/22
PDUs in England
PDUs in Wales
95% level (2 SD)
99% level (3 SD)
Mean (England and Wales)

 
National Paediatric Diabetes Audit Report on Care and outcomes 2021/22 
 
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85.9% received level three carbohydrate counting education within a fortnight of diagnosis, compared 
to 82.1% in 2020/21. 
 
91.2% received screening for thyroid disease within three months of diagnosis, compared to  
86.6% in 2020/21. 
 
87.0% received screening for coeliac disease within three months of diagnosis, compared to 83.8% in 
2020/21. 
 
 
Figure 4: Median HbA1c for children and young people with all types of diabetes in England and Wales, 2009/10 to 2021/22 
 
 
 
2009/10
2010/11
2011/12
2012/13
2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
2019/20
2020/21
2021/22
England
73.0
72.0
71.0
69.0
69.0
66.5
64.5
64.0
64.0
61.5
61.5
61.0
60.5
Wales
72.0
70.0
71.0
70.0
69.0
68.3
64.5
64.0
64.5
62.0
61.5
62.0
61.5
60
62
64
66
68
70
72
74
Median HbA1c (mmol/mol)
England
Wales

National Paediatric Diabetes Audit Report on Care and outcomes 2021/22 
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The national overall median HbA1c for children and young people with all types of diabetes was 60.5 
mmol/mol (60.5 mmol/mol for England and 61.5 mmol/mol for Wales), down from 61.0 mmol/mol in 
2020/21. 
The national median HbA1c for Type 1 diabetes was 61.0 mmol/mol (unchanged from 2020/21). The 
median HbA1c at PDU level ranged from 54.0 mmol/mol to 69 mmol/mol. 
The national median HbA1c for Type 2 diabetes was 50.0 mmol/mol, down from 53.0 mmol/mol in 2020/21. 
Figure 5 shows considerable variation at PDU level in terms of case mix adjusted mean HbA1c for those 
with Type 1 diabetes. 
Figure 5: Funnel plot of mean adjusted HbA1c by PDU for those with Type 1 diabetes. 
50
55
60
65
70
75
80
0
100
200
300
400
500
600
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)

 
National Paediatric Diabetes Audit Report on Care and outcomes 2021/22 
 
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TYPE 1 DIABETES 
TYPE 2 DIABETES 
29.9% (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 31.0% in 2020/21. 
46.1% (all ages)   
had a diastolic or systolic blood pressure  
in the hypertensive range (>98th centile  
after correction for age and gender), compared to 
49.3% in 2020/21. 
19.0% (aged 12 and above)  
had a total blood cholesterol of 5mmol/l or higher, 
compared to 19.8% in 2020/21. (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).  
27.9% (all ages )   
had a total blood cholesterol of 5mmol/l  
or higher,  compared to 26.8% in 2020/21. 
42.3% (all ages) were overweight or obese (BMI>85th 
centile after correction for age and gender), 
compared to 42.9% in 2020/21. 
92.8% (all ages) were overweight or obese (BMI 
>85th centile after correction for age and gender), 
compared to 92.0% in 2020/21. 
11.4% (aged 12 years and above) had an abnormal 
retinopathy screen, compared to 16.9% in 2020/21.  
8.4% (aged 12 years and above) had an abnormal 
retinopathy screen, compared to 3.5% in 2020/21. 
11.5% (aged 12 years and above) had micro- or macro- 
albuminuria, compared to 10.3% in 2020/21. 
20.6% (all ages) had micro- or macro-albuminuria, 
compared to 23.4% in 2020/21. 

 
National Paediatric Diabetes Audit Report on Care and outcomes 2021/22 
 
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IN ENGLAND AND WALES: 
40.3% were using an insulin pump, compared to 38.5% in 2020/21.  
7.5% were using a closed loop system (data not collected in 2020/21). 
30.0% were using a real time continuous glucose monitor (rtCGM); either combined with insulin 
injections or a pump), compared to 27.9% in 2020/21. 
43.7% were using a flash glucose monitor or a modified flash monitor (data not collected in 2020/21). 
 
 
 
 
Figure 6: Mean HbA1c for children and young people with Type 1 diabetes using different combinations of treatment regimen and 
glucose monitoring in 2021/22. 
Country 
Insulin pump 
Closed-loop system 
rtCGM 
Flash glucose monitor or 
modified flash monitor 
England 
40.2% 
7.4% 
29.5% 
44.3% 
Wales 
42.6% 
9.4% 
40.8% 
30.1% 
England and Wales 
40.3% 
7.5% 
30.0% 
43.7% 
Injections
Injections + Flash
Injections + CGM
Pump
Pump + Flash
Pump + CGM
Closed-loop
system
Number of children
4,985
7,593
2,463
1,390
3,719
3,540
2,232
Mean HbA1c (mmol/mol)
68.6
66.1
62.0
64.7
62.3
58.8
56.8
50
55
60
65
70
Mean HbA1c 
(mmol/mol)

 
National Paediatric Diabetes Audit Report on Care and outcomes 2021/22 
 
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Figure 7: Percentage of children and young people with Type 1 diabetes admitted at least once for a diabetes-related cause not 
associated with diagnosis, 2020/21 and 2021/22 
 
25.6% of children and young people newly diagnosed with Type 1 diabetes presented with DKA at 
diagnosis in 2021/22 compared to 25.8% in 2020/21.  
 
 
39.0% of those with Type 1 diabetes and known outcome of psychological assessment (n=21,616) were 
assessed as requiring additional psychological support outside of multidisciplinary team meetings  
compared to 46.5% in 2020/21. 
48.3% of those with Type 2 diabetes and known outcome of psychological assessment (n=636) were 
assessed as requiring additional psychological support outside of multidisciplinary team meetings 
compared to 59.5% in 2020/21. 
 
DKA
Hypoglycaemia
Ketosis without acidosis
Stabilization
2020/21
1.8%
0.6%
0.8%
1.7%
2021/22
2.4%
0.9%
0.9%
1.9%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
% of those with Type 1 diabetes 
admitted at least once

 
National Paediatric Diabetes Audit Report on Care and outcomes 2021/22 
 
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Spotlight on inequalities 
 
NPDA results have shown persistent inequalities in HbA1c outcomes and use of diabetes-related 
technologies associated with age, sex, deprivation and ethnicity.  
 
 
Figure 8: Mean HbA1c by ethnic group for those with Type 1 diabetes, 2013- 2022.  
 
 
 
Figure 9: Mean HbA1c by deprivation quintile for those with Type 1 diabetes, 2013- 2022. 
 
2013 /14
2014 /15
2015 /16
2016 /17
2017 /18
2018 /19
2019 /20
2020 /21
2021 /22
Most deprived
74.7
73.7
71.6
70.7
70.9
68.2
68.3
67.8
67.6
Second most deprived
74.0
72.3
69.6
68.7
68.7
66.2
66.1
65.2
65.1
Third least deprived
72.2
70.6
68.1
67.0
67.5
65.0
65.1
64.4
63.3
Second least deprived
70.4
69.0
66.7
65.6
65.9
63.4
62.7
62.3
61.8
Least deprived
69.0
67.2
64.8
64.0
64.2
61.9
62.0
60.7
60.1
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
White
70.5
69.9
67.7
66.7
67.0
64.6
64.6
63.9
63.4
Asian
72.5
72.2
69.3
68.7
68.8
66.2
65.8
65.2
65.0
Black
78.0
77.8
74.0
74.2
74.9
71.4
71.9
70.9
70.7
Mixed
73.7
73.3
70.6
68.7
69.6
67.5
67.4
67.2
66.4
Other
72.1
72.3
69.6
68.2
67.0
63.7
63.0
63.3
62.7
55
60
65
70
75
80
Mean HbA1c (mmol/mol)

National Paediatric Diabetes Audit Report on Care and outcomes 2021/22 
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 Figure 10: Mean HbA1c by sex for those with Type 1 diabetes, 2013- 2022. 
Figure 11: Use of rtCGM by ethnic category and deprivation quintile amongst those with Type 1 diabetes: 2019- 2022. 
2013 /14
2014 /15
2015 /16
2016 /17
2017 /18
2018 /19
2019 /20
2020 /21
2021 /22
Boys
70.2
69.8
67.5
66.6
67.0
64.7
64.7
63.7
63.2
Girls
72.0
71.4
69.1
68.1
68.0
65.4
65.3
64.8
64.4
55
60
65
70
75
80
Mean HbA1c (mmol/mol)
Mixed
White
Other
Asian
Black
Most
Second
most
Third
least
Second
least
Least
Ethnicity
Deprivation
2019 /20
18.5%
20.2%
16.0%
15.1%
11.7%
14.0%
17.3%
19.3%
22.3%
25.2%
2020 /21
29.3%
28.4%
28.1%
25.3%
21.9%
23.8%
24.9%
27.8%
29.8%
34.7%
2021 /22
31.3%
30.8%
26.9%
25.4%
22.2%
23.9%
25.7%
31.1%
32.7%
37.7%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
% children and young people with
Type 1 Diabetes using rtCGM

National Paediatric Diabetes Audit Report on Care and outcomes 2021/22 
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Figure 12: Use of insulin pump therapy by ethnic category and deprivation quintile amongst those with Type 1 diabetes: 2019- 2022 
White
Mixed
Other
Asian
Black
Most
Second
most
Third
least
Second
least
Least
Ethnicity
Deprivation
2019 /20
39.8%
34.9%
35.0%
29.7%
26.7%
31.7%
35.8%
37.5%
42.4%
44.3%
2020 /21
40.2%
37.8%
34.6%
31.1%
27.4%
32.5%
36.3%
38.4%
42.4%
44.0%
2021 /22
42.2%
38.0%
37.7%
33.0%
29.0%
34.0%
38.8%
41.1%
44.1%
45.1%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
% children and young people with
Type 1 diabetes using an insulin pump

National Paediatric Diabetes Audit Report on Care and outcomes 2021/22 
15 
Patient story:  
Using a closed loop system 
The 2021/22 report has demonstrated that use of a closed loop system is associated with the lowest 
average HbA1c compared to other insulin delivery and glucose monitoring combinations. Here, Katie 
L aged 17 shares her experience of using this technology.  
I was diagnosed with Type 1 diabetes aged 13. 
I moved relatively quickly from multiple daily injections to an insulin pump including access to a Freestyle 
Libre from early on following the diagnosis. 
I did not anticipate that diabetes would change my life as much as it would and that participating in all 
the sport I had before was a lot harder than expected. Staying in sport was initially the most important 
thing for me, however, I’ve learnt that staying active is also a huge part of living well with diabetes and 
controlling blood sugars. Participation in sport, particularly prolonged events, is not easy with Type 1 
diabetes. Despite frequent testing and careful planning of meals and snacks, it was difficult to avoid 
hypoglycaemia during and after exercise, or to manage the pre-race hyperglycaemic nerves. My sugar 
was frequently low overnight after particularly active days. 
My diabetes team suggested that I try a closed loop system. With their help, I began using one. 
This has been a fantastic step forward for me. My HbA1c has improved a little but, more importantly, my 
time in target has significantly improved. This is because I am having less hypoglycaemic episodes, during 
the day and overnight. In fact, my overnight blood sugar readings are commonly a completely straight 
line – previously unheard of! This gives me the confidence to remain active during the day and I rarely 
worry about my blood sugar overnight. 
My experience of closed loop systems is that they require considerable confidence and motivation to use, 
and consistent access to Bluetooth wireless technology. The systems are not yet familiar to the wider 
population so can require quite extensive explanations, for example at school / college, during sports 
events, and, more recently for me, during driving lessons and tests.  
I would like diabetes teams and policy makers to work with young people and families to develop better 
education and support for families new to these devices. I am sure that there is a growing number of 
young people familiar and confident with closed loop systems who would be keen to share their 
experiences and expertise with others, perhaps with the support of the diabetes charities. 
Quality Improvement resources 
•
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.

National Paediatric Diabetes Audit Report on Care and outcomes 2021/22 
16 
©2023 Healthcare Quality Improvement Partnership. 
Published by RCPCH March 2023 
National Paediatric Diabetes Audit (NPDA) 
Report on Care and outcomes 2021/22