Paediatric Diabetes – Annual Review

Why is an Annual Review Required?
Anyone with diabetes is at risk of developing a number of long-term complications that
are associated with it. These include heart disease, a stroke, diabetic foot problems,
eye disease and kidney disease. Please see the patient information leaflet regarding
complications which talks about these in more detail.

It is known that complications can begin in some people 5 years after they are diagnosed
and especially from puberty onwards in a young person with diabetes.

The risks are increased by the following factors:
 Having regularly high blood glucose levels above the pre meal 4-7 mmol/l range
 A high HbA1c, above 48mmol/mol
 Being overweight
 Smoking
 When you reach adulthood you can also increase your risk if you have a high blood
pressure or a high cholesterol level

You can never be sure that you will not experience complications but you can improve
your chances of delaying them by looking after yourself and attending your Annual
Review.

At the Annual Review
Each year one of your appointments at the clinic will be for an Annual Review. This
review checks for the earliest signs of complications. If complications are picked up
early, then prompt treatment, an improvement in your HbA1c or a change in lifestyle,
can very often slow down progression or reverse the complication and prevent further
problems developing.

What tests are carried out?

Under 12 years
 You will have a blood test to check your thyroid gland is working properly and to
check for coeliac disease once a year. Both can be more common in children with
diabetes. Your HbA1c will also be checked as it is at every clinic appointment.
 Your blood pressure will be checked.
 Your growth will be checked by measuring your height and weight and also working
out your body mass index (BMI). This is your ideal weight for your height.

12 years and over
In addition to the above investigations you will also:

 Have an additional test done at your blood test. This will include your cholesterol
(the fat levels in your blood) to check they are at a healthy level.
 Have your urine checked for something called microalbuminuria (the amount of
protein in your urine). If found, it can be a very early sign of kidney problems.
 You will be invited to have your eyes screened for retinopathy by a separate service
that carries this test out. This usually involves having some eye drops put into your
eyes to dilate the pupils and then a digital camera takes a picture of the back of
your eye to check for early signs of the disease. Where you go for this will depend
on where you live. Your diabetes team will advise you on how this will happen.
 The clinic team will review your current diabetes treatment; check your injection or
cannula sites are healthy; that your feet are in good condition and that you can feel
your feet being touched.
 Together, you and your diabetes team will also discuss goals to improve your
diabetes care until the next clinic appointment.

If there are early signs of complications, your doctor may want to do further tests and
will discuss further treatment options with you.

This appointment is a good opportunity to get your questions answered and to
think about your diabetes and how you can make improvements.

If your symptoms or condition worsens, or if you are concerned about anything,
please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you
and your loved ones. If you have any questions or concerns, please do speak with a
member of staff on the ward or in the relevant department who will do their best to
answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well
and where improvements can be made. There are lots of ways you can share your
experience with us including completing our Friends and Family Test – cards are
available and can be posted on all wards, departments and clinics at our hospitals. We
value your comments and feedback and thank you for taking the time to share this with
us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the
nurse in charge or the department manager in the first instance as they are best placed
to answer any questions or resolve concerns quickly. If the relevant member of staff is
unable to help resolve your concern, you can contact the PALS Team. We offer informal
help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf,
if you feel unable to do so, to resolve your problems and where appropriate refer to
outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate
your concerns. You can make a complaint orally, electronically or in writing and we can
advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please
be aware that you may need to leave a voicemail message, but we aim to return your
call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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