Endocrine Abstracts

Background: The transition period is a challenging time for adolescents and is frequently associated with deterioration of HbA1c, decreased attendance, and disengagement from services. Two London hospitals both have existing transition programs to facilitate the movement of patients with diabetes from paediatric to adult care services.

Aim: This audit aimed to assess mean HbA1c values, HbA1c monitoring frequency, and appointments offered and attended in the year before and after transition.

Method: For diabetes patients transitioning to the adult services between February 2017 and March 2019, HbA1c measurements and number of appointments data in the year pre- and post-transition were recorded. Audit standards were developed from relevant paediatric and adult NICE guidelines.

Results: A total of 33 patients underwent transition and one patient had their care transferred to their GP. Three (9.1%) of those patients who transitioned did not attend any clinics in the year after transition and were lost to follow up. Following transition, no significant change in mean HbA1c was seen (74.1 ± 23.6 vs 76.2 ± 24.6 mmol/mol, p>0.05), but there was a significant reduction in mean frequency of HbA1c monitoring (3.1 ± 1.4 vs 1.3 ± 0.8, P < 0.001). A significant reduction in appointments offered (8.3 ± 2.4 vs 5.8 ± 2.7, P < 0.001) and attended (5.1 ± 3.1 vs 3.7 ± 2.4, P < 0.001) was seen after transition. Despite this there was no significant difference in attendance rate for the cohort as a whole (67.5 ± 28.5% vs 66.4 ± 33.0% p>0.05). Most patients (81.3%) met their adult care providers before transition, but many patients were not meeting NICE recommendations for HbA1c targets of 48 mmol/mol (9.1% in paediatric care vs 6.3% in adult care).

Conclusion: Mean HbA1c and attendance rate does not vary significantly after transition to adult care and loss to follow-up was minimal, indicating that the current process is effective in maintaining similar treatment standards to pre-transfer. The audit shows that most patients do meet their adult care providers and highlights scope for improvement to achieve NICE guidelines for HbA1c monitoring.