BSPED2018 Oral Communications Oral Communications 6 (3 abstracts)
A retrospective regional analysis of outcomes during transition of young people with type 1 diabetes
Melanie Kershaw 1 , Marie Atkins 1 , Suzanne Digwood 2 , Hilary McCoubrey 1 , Marie McGee 1 , Nisha Pargass 3 , Rajeev Raghavan 3 , Raphaella Rookes 4 , Justina Rweyemamu 4 , Sailesh Sankar 5 , Rebecca Skelding 6 , Lesley Swift 7 & Kerrie Williams 4
1Birmingham Children’s Hospital, Birmingham, UK; 2Shropshire Community Healthcare Trust, Birmingham, UK; 3Royal Wolverhampton NHS Trust, Birmingham, UK; 4Birmingham Heartlands Hospital, Birmingham, UK; 5University Hospital Coventry and Warwickshire, Coventry, UK; 6University Hospital Birmingham, Birmingham, UK; 7Birmingham Children, Birmingham, UK.
Objectives: Transition from paediatric (PC) to adult diabetes care (AC) is a vulnerable period for young people (YP). The West Midlands (WM) Regional Paediatric Diabetes Network conducted a region-wide study of Diabetes transition outcomes to identify 1. Areas of good practice, 2. Risk factors for poorer outcomes, 3. Regional objectives for services and 4. Provide baseline data against which future performance can be measured.
Methods: Retrospective regional audit of follow up and HbA1c 12 months pre and 24 months post transfer in YP transitioning between January 2012 and December 2013.
Results: Data was submitted by 9 of 13 (69%) Trusts, accounting for 298 YP moving from PC to transition clinic (TC), and 195 from TC to AC. 41/298 (13.8%) YP were lost to follow up (FU) in TC (range 0–29%). 41/195 (21%) were lost to FU within 2 years of AC (range 0–40%). Median age at move to AC was 17.8 years, range 16 -19.84 years. 22%, were seen in AC within 3 months of their last TC visit. For 45% and 13% their first AC visit occured 6–12 and >12 months respectively, following their last TC. Pre and post HbA1c data was available on 144 YP (73%) transferring from TC to AC. Median HbA1c was 75 (Trust range 64–83) mmol/mol in the year prior to AC and 78mmol/mol (Trust Range 63.5 to 89.5) in first 2 years of AC. Lag time between the TC and first AC visit did not correlate with HbA1c. YP in TC with HbA1c <53 (7.5%) deteriorate (P=0.028), and HbA1c >9.0% improve (P<0.00009) on move to AC. Age at move to AC positively correlates with fall in HbA1c (R=−0.201, P=0.048).
Conclusion: WM Trusts need to focus on
1. Reducing high lost to FU rates of 1 in 5 YP (up to 1 in 2.5 in some Trusts)
2. Reducing lag time from TC to first AC.
3. Careful consideration could be given to transferring some YP in TC with HbA1c > 9.0% to AC at an earlier point.
4. Further studies should look at impact of age and deprivation on rates of attrition following move to AC.
Volume 58
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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