Aims:
“Characteristics of young adults with diabetes in transition clinic”
Background
Transition from paediatric to adult diabetes care can be high-risk. Shifting priorities in late teens and early twenties of education or new employment is layered above psychiatric co-morbidities, possible drug/alcohol use and other risk taking behaviours. Identifying clinical needs of this population can guide future service development and reduce risk.
Methods:
A retrospective review of medical records was undertaken of all patients attending a transition diabetes clinic in a teaching hospital between 2012 and 2016. The review occurred between September and November 2016. Data collected included demographic and diabetes related clinical variables.
Results:
102 patients were identified. Of these, 80 (78.4%) were still attending the transition clinic; 15 (14.8%) were lost to follow up and the remainder had transferred to another specialist diabetes service. 11 (10.8%) did not have type 1 diabetes. Of 91 patients with type 1 diabetes (T1DM), mean age at first assessment was 19±2 years. At last assessment, body mass index was 25.2±4.7 kg/m2, duration was 11±6 years, 43 (47%) were female, 22 (24%) used continuous subcutaneous insulin infusions (CSII) and 71 used multiple daily injections (MDI) of insulin. Among those with T1DM, known mental health issues were common (59%) as were prior pregnancies (23%) and diabetic ketoacidosis (DKA) since diagnosis (39%). Those with DKA were not significantly different from other patients besides a higher mean HbA1c (8.6±1.7% vs. 10.0±2.3% p=0.001) and number of clinic attendances (8±5 vs. 5±4; p=0.008). Presence of mental health issues was non-significantly higher (54% vs. 69% p=0.16).
Conclusions:
Young adults with diabetes remain a high risk population. Patient loss to follow up, poor glucose control, mental health issues, DKA and pregnancy are significant concerns warranting review of current processes of care and investment in joint approaches especially with mental health services.