ESPE2021 ePoster Category 2 Diabetes and insulin (72 abstracts)
A quality improvement project of a Young Adult Diabetes (YAD) service at a UK specialist centre.
Dhruti Hirani 1 , Rebecca Unsworth 1 , Adil Mahmood 1 , Emma Jones 1 , Farzana Begum 1 , Carol Jairam 1 , Soraia Vieria 2 , Chris Bound 2 , Zalalem Mengistu 2 , Sheba Jarvis 1 , Karen Logan 2 , Nick Oliver 1 , Mando Watson 2 & Monika Reddy 1
1Department of Diabetes and Endocrinology, St Mary’s Hospital, London, United Kingdom; 2Department of Paediatrics, St Mary’s Hospital, London, United Kingdom
Introduction: The joint young adult diabetes (YAD) service at a specialist UK centre facilitates transition from paediatric to adult diabetes care for young people (YP) aged 16-25 years. Since 2018, quality improvement interventions have included focus groups with young people, joint paediatric and adult specialist nurse appointments and recruitment of a type 1 diabetes educator. We assess the impact of these interventions and changes imposed by the Covid-19 pandemic on clinic attendance and diabetes control in the 19-25 year old cohort.
Methods: YAD service data was retrospectively collected for: April 2018-March 2019 (year 1), April 2019-March 2020 (year 2) and April 2020-March 2021 (year 3 – COVID-19 pandemic). Outcomes of interest included technology uptake, HbA1c and clinic attendance. ‘Did not attend’ (DNA) rates were calculated as a percentage of all appointments offered, excluding those rescheduled or cancelled prior to the clinic start.
Results: The number of YP within the service increased over the 3 years (n = 57 (year 1); n = 75 (year 2); n = 88 (year 3)). All had type 1 diabetes mellitus with the exception of one who had early onset type 2 diabetes. Table 1 summarises our key findings. Year 3 had the lowest overall DNA rate. Median HbA1c improved over the years, with greater proportions of YP achieving a target HbA1c <58mmol/mol. Over time, multiple dose injection (MDI) use declined and uptake of insulin pumps, FreeStyle Libre (FSL) and real-time Continuous Glucose Monitoring (rtCGM) increased. Emergency department (ED) attendances and hospital admissions particularly reduced in year 3. Of all ED attendances, the proportion of YP presenting with diabetic ketoacidosis (DKA) also reduced over time.
| Year 1 (n = 57) | Year 2 (n = 75) | Year 3 (n = 88) | |
| Min. 1 appointment attended in year, % | 79 | 76 | 81 |
| DNA rate, % | 41 | 41 | 27 |
| HbA1c <58mmol/mol, n(%) | 8 (17) | 15 (23) | 18 (33) |
| Median HbA1c, mmol/mol (IQR) | 76 (64-92) | 71 (60-86) | 66 (54-82) |
| MDI, n(%) | 44 (77) | 57 (76) | 57 (65) |
| Insulin Pump, n(%) | 12 (21) | 18 (24) | 29 (33) |
| FSL, n(%) | - | 26 (35) | 40 (45) |
| rtCGM, n(%) | - | 7 (9) | 15 (17) |
| Min. 1 ED attendance, n | 12 | 20 | 7 |
| ED presentations due to DKA, n(%) | 18 (60) | 20 (57) | 0 (0) |
Conclusion: There has been an improvement in engagement and diabetes control over time. Based on focus group outcomes, we plan to initiate group education sessions and permanently integrate flexible consultations, allowing YP the option of virtual or face-to-face appointments.
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