ObjectivesTo evaluate the usefulness and effectiveness of a new structured education module for children with type 1 diabetes: Structured Education Reassuring Empowering Nurturing (SEREN) ‘Diabetes at Diagnosis’.DesignRetrospective questionnaire-based service evaluation.Setting12/14 paediatric diabetes centres across Wales took part.ParticipantsChildren diagnosed with type 1 diabetes 1 year before (pre-SEREN group) and 1 year after the introduction of SEREN (post-SEREN group) were selected using a national diabetes register.Resource‘Diabetes at Diagnosis’ delivers structured education to empower children and families with self-management of type 1 diabetes.EvaluationPrimary outcomes were patient-reported effectiveness and user-friendliness of the educational resources and quality of life (PedsQL). Age-appropriate child and parent questionnaires were provided. Clinical outcomes included glycated haemoglobin (HbA1c) at 6 and 12 months, service engagement and diabetes-related hospital admissions in the first year.Results89/106 responded pre-SEREN and 108/115 post-SEREN, with no demographic differences at diagnosis. Parent scores for educational package evaluation significantly improved post-SEREN, with a non-significant trend towards improved results in children. PedsQL scores were similar. There was no change in HbA1c overall. Subgroup analyses at 12 months showed a trend towards a lower HbA1c in key stage 1–2 (62 vs 58 mmol/mol, p=0.06) and increased HbA1c in key stage 3–4 (56 vs 66 mmol/mol, p=0.009). There were no differences in hospital admissions or missed clinic appointments.ConclusionsThis is an evaluation of the only standardised type 1 diabetes structured education programme in use for children throughout Wales. This module improved parent-reported outcomes and showed a non-significant trend towards improved usefulness in children, without a difference in a PedsQL scores overall. Ongoing evaluation of the cohort who received subsequent SEREN modules may show the long-term benefit of the programme.

Table 1 Endoscopic investigations & findings Investigation Performed <1 year before ACS (n = 113) Performed <1 year after ACS (n = 113) Overall Incidence of significant findings Gastroscopy 10% 19% 28% Lower Gi investigations (Colonoscopy, sigmoidoscopy or CT pneumocolon) 11% 17% 32%Only a minority of patients had endoscopic investigations for anaemia (table 1). Significant findings (ulcers, active bleeding or cancer) were found at 28% gastroscopy more commonly in patients with STEMI (45%). Significant findings (polpys, cancer, proctitis) were found at 32% lower GI investigations. No endoscopic complications occurred.69% STEMI and 27% NSTEMI patients had coronary stenting. 81% patients were discharged on dual antiplatelet therapy and 16% on anti-coagulation. 1-year outcome data were available for 99/113. Crude mortality was 24%. 7.1% patients developed overt GI bleeding during admission or in the year after ACS. Conclusions Anaemia is common in patients presenting with ACS. Adequate gastrointestinal investigations were only performed on a minority of these patients but when completed showed a high incidence of iron deficiency and important findings at endoscopy. This patient group has a significant risk of both bleeding and ischaemia and could benefit from complete investigation of their anaemia.

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relevance as a considerable number of lesions are missed in the upper GI tract in patients undergoing gastroscopy.