Quality standard

Quality statement 5: Blood ketone monitoring in type 1 diabetes

Quality statement 5: Blood ketone monitoring in type 1 diabetes

Quality statement

Children and young people with type 1 diabetes are offered blood ketone testing strips and a blood ketone meter.

Rationale

Insufficient insulin can lead to increased ketone levels, which, if untreated, can lead to progressive dehydration and diabetic ketoacidosis (DKA). The risk of DKA is increased if a child or young person with type 1 diabetes has an illness such as flu or a urinary tract infection, or has missed some insulin doses. NICE's guideline on diabetes (type 1 and type 2) in children and young people suggests that blood ketone testing is more cost effective than urine ketone testing for preventing hospital admission during intercurrent illness. It is important not to use out‑of‑date testing strips because the result might not be accurate. Education on how to prevent, detect and manage increased ketone levels is also vital.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that children and young people with type 1 diabetes are offered blood ketone testing strips and a blood ketone meter.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from local protocols.

Process

Proportion of children and young people with type 1 diabetes who receive blood ketone testing strips and a blood ketone meter.

Numerator – the number in the denominator who receive blood ketone testing strips and a blood ketone meter.

Denominator – the number of children and young people with type 1 diabetes.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

a) DKA.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. Included in the Royal College of Paediatrics and Child Health National Paediatric Diabetes Audit.

b) Hospital admission rates of children and young people with type 1 diabetes.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. Included in the Royal College of Paediatrics and Child Health National Paediatric Diabetes Audit.

c) Satisfaction of children and young people with type 1 diabetes and their family members or carers (as appropriate) with blood ketone testing strips and blood ketone meters.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient satisfaction surveys.

What the quality statement means for different audiences

Service providers (primary and secondary care providers) ensure that systems are in place to offer children and young people with type 1 diabetes blood ketone testing strips and a blood ketone meter.

Healthcare professionals (such as GPs and consultants) offer children and young people with type 1 diabetes blood ketone testing strips and a blood ketone meter, and advise them and their parents or carers on how to prevent, detect and manage increased ketone levels.

Commissioners commission services that offer children and young people with type 1 diabetes blood ketone testing strips and a blood ketone meter.

Children and young people with type 1 diabetes are offered blood ketone testing strips and a blood ketone meter to measure ketones in their blood. When people need more insulin (because they are ill or have missed some insulin doses), their body makes ketones, and too many ketones can make people very ill – this is called diabetic ketoacidosis, or DKA for short.

Equality and diversity considerations

Children and young people with type 1 diabetes and their family members or carers (as appropriate) should be provided with information about blood ketone monitoring that they can easily read and understand themselves, or with support, so they can communicate effectively with health and social care services. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate and age appropriate. People should have access to an interpreter or advocate if needed.

For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.