Introduction: Type 1 diabetes has a major impact on not only the person diagnosed, but also their families/carers. Diabetes control is affected by many factors. Our diabetes patient cohort has a very high level of social burden which we feel impacts significantly on the management of their diabetes.
Methods: We performed a retrospective analysis of all young people supported by the Evelina London Childrens Hospital diabetes team in 2017 looking at age, gender, ethnicity and last HbA1C level. We also reviewed all admissions including those in Diabetes Ketoacidosis (DKA) to A&E and the ward between 2014 and 2017 excluding newly diagnosed patients. We defined social burden as: those known to Social Services and Youth Offending services; housing issues; financial difficulties; complex medical needs; immigration/language issues; those who have poor engagement with our service.
Results: 93 patients, mean age of 11.7 years (1.617.8 years), were divided into two groups: Group 1 (n=52, 56%) with one or more identified social issues (26 required Social Services involvement) and Group 2 (n=41, 44%) with no social issues.The mean HbA1c in Group 1 was 10% and for Group 2 8.9%. Mean HbA1c for females was 10.2% in Group 1 and 9.4% in Group 2. In males it was 9.7% and 8.5% respectively. Regarding ethnicity there was an equal distribution of ethnicities in both groups, however in Group 1 the HbA1c was higher for: White, Asian, Black British, Black/Other and unspecified, than their peers in Group 2. Group 1 had a total of 74 admissions to A&E, 29 of which were due to DKA while Group 2 had 20 admissions with 6 DKA in the same period. The maximum number of admissions per patient was 11 in the first group and 2 in the second. The first group had 56 inpatient admissions compared to 11 in the other group.
Discussion: From our type 1 diabetes patient cohort the group with higher social burden was found to have higher mean HbA1c, more A&E and ward admissions, including more and recurrent DKA episodes.This has a significant impact on their glycaemic control and ultimately their health and long term well-being. We believe that patients with diabetes who have higher levels of social burden often face other more pressing social issues which means that the childs diabetes is not always the main priority. Future research may wish to consider what forms of psycho-social support could help address this.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology