Endocrine Abstracts

We initiated a ‘Non Type 1/Medically Complex Type 1’ Diabetes Clinic in a tertiary paediatric diabetes service in July 2023. Prior to this, patients were seen in the routine clinic which presented some challenges. This clinic has allowed a more focused review of patients with complex diabetes. Our current patient cohort is 25 patients. Monogenic Diabetes accounts for 12 patients with HNF1A, HNF1B, HNF4A, KCNJ11, GCK and RFX6 mutations. Other diagnoses include Wolfram Syndrome, Cystic Fibrosis Diabetes (CFD), post pancreatectomy/pancreatitis diabetes and diabetes in association with transfusion dependent beta thalassemia. Some medically complex patients with type 1 diabetes are also seen in the clinic. These include patients with Chronic Antibody-Mediated Labile Glycaemia, Sensenbrenner syndrome, GLUT1 Transporter Deficiency Syndrome and post Langerhans Histiocytosis X. There is also a metabolic patient with dysglycaemia and no unifying diagnosis. The management of the monogenic patient group has been focused on optimising their current therapy to ensure they are receiving the most appropriate treatment. This has included supporting the weaning of insulin and establishing patients on alternative oral therapies. It has facilitated multi-specialty working, improving communication between professionals and has helped to avoid patients ‘having to tell their story all over again’. This has helped give continuity of care to this complex group of patients. We have been able to signpost families to parent support groups/education days and condition specific resources. The clinic has worked collaboratively with the West of Scotland Centre for Genomic Medicine, East of Scotland Regional Genetics Service, Exeter Genomics Laboratory and the Wolfram Syndrome Clinic in Birmingham Children’s Hospital. Regular Non Type 1 Diabetes Clinical Meetings were also established to support the clinic. The referral route into clinic is usually via this meeting. Patients have also been discussed at the joint adult/paediatric virtual Scottish ‘Diabetes Diagnosis Advice Clinics’. In conclusion, there have been many benefits to both the patients and healthcare professionals attending this clinic. It has allowed us to optimise management in a holistic manner and learn from shared experience for these rarer forms of diabetes.