Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Diabetes health service usage of young people with type 1 diabetes after transition from paediatric to adult care (#354)

Lin Perry 1 , Janet S Dunbabin 2 , Xiaoyue Xu 1 , Julia M Lowe 3 , Shamasunder Acharya 4 , Kate M Steinbeck 5
  1. University of Technology Sydney, Randwick, NSW, Australia
  2. University of Newcastle, Callaghan, NSW, Australia
  3. University of Toronto, Toronto, Canada
  4. Hunter New England Local Health District, Newcastle, NSW, Australia
  5. University of Sydney and, The Children's Hospital Westmead, NSW, Australia

Rationale, aims and objectives:

The period when young people with diabetes transition from paediatric to adult diabetes care is internationally recognised as problematic but few data describe subsequent service use. This study aimed to identify: in the first two years following young people with diabetes’ last planned appointment with paediatric diabetes services:

1) How many diabetes-related planned contacts with diabetes specialists (physicians/ endocrinologists, diabetes educators and dietitians), unplanned acute care occasions of service (emergency department presentations and hospital admissions) and HbA1c measurements do they experience?

2) What factors are linked to rates of planned and unplanned diabetes-related service usage?  Are rates of planned/ unplanned diabetes-related service usage associated with glycaemic control and development of vascular complications? 

Method:

We audited healthcare records of a major public health provider in New South Wales for all young people with type 1 diabetes transferring from paediatric to adult public services in 2010-2013. Details of service usage included planned and unplanned diabetes-related occasions of service, measurements and values of HbA1c, insulin pump use, blood pressure, evidence of retinopathy, nephropathy and neuropathy. 

Results:

Of 172 young people with diabetes, 48.3% were female and 57.7% lived in metropolitan areas. In their first two years with adult services, despite some improvements, 21% had no planned specialist care; 49% accessed acute services for diabetes-related problems. Those living in metropolitan areas and those using insulin pumps were more likely to access specialist care, less likely to use acute services for unplanned care. Those achieving a minimum of nine planned care contacts over two years were more likely to use an insulin pump and to have shorter duration between last paediatric and first adult visit. 

Conclusion:

Lack of specialist care in early adult years and non-metropolitan relative disadvantage continue to compromise the present and future health of young people with diabetes.