Endocrine Abstracts

Introduction: Achieving optimum glycaemic control in young adults is challenging. Furthermore, transfer of care to adult services has been associated with deterioration in glycaemic control. We aimed to establish glycaemic control and rate of microvascular complications in young adults with childhood onset type 1 diabetes (T1D) and looked specifically at a subset of patients before and after transfer to adult care.

Methods: A retrospective study of patients with T1D currently attending the transition clinic and those transferred to adult services between August 2009 and August 2012 at a single tertiary centre.

Results: A total of 104 (55 males) patients with a median age of 19.2 years (range: 17–23) and mean duration of diabetes of 9.4±3.9 years were identified. Mean HbA1c was 77±18 mmol/mol. Majorities were on multiple daily injections (66.3%) and others on pump (27.9%) and twice daily injection regimen (5.8%). Microalbuminuria was noted in 5.6% and retinopathy in 43.2% with the majority (41.3%) having only background changes. 14% had raised blood pressure but ambulatory BP was normal.

54 patients were in transition clinic and 50 post transfer to adult care. In the latter group, mean age of transfer was 18.5±1.2 years. Mean HbA1c 1 year pre and post transfer was similar (78±20 and 78±22 mmol/mol, respectively; P=0.22). Mean HbA1c 2 and 3 years pre and post transfer were also similar. Clinics attended per calendar year before and after transfer were 3.2 vs 2.4. A small subset of patients (n=7) who opted for e-mail support demonstrated improved mean HbA1c over 1 year from 68±8 to 63±10 mmol/mol, P=0.051.

Conclusions: Glycaemic control is stable following transfer of care of young diabetes patients with only 12.5% achieving national targets of HbA1c (<58 mmol/mol). Large percentages of patients have retinopathy, although majorities have background changes only. Email support may represent one strategy to improve glycaemic control in this population and warrants further investigation.