G590(P) Impact of transition on diabetes related outcomes

Abstract

Introduction The period of adolescence for young people (YP) with diabetes is a significantly high-risk time and is linked with worsening metabolic control, non-adherence to treatment, and increased risk of mental health issues. Arranging an efficient and smooth transfer for young person with type 1 diabetes (T1DM) from paediatric to adult care is one of the great challenges facing the diabetes multidisciplinary teams. Aim of the study This audit looks at the diabetes related health-outcomes for YP who transitioned over a 2 year period in a DGH. Methods A retrospective audit of diabetes related outcomes for YP who transitioned in the years 2014 and 2015 was conducted. Data was collected from paper and electronic patient records with regards to number of clinic attendances, HbA1c, keyworker, support from dietitian and psychologist. The data for the 12 months preceding the transfer was compared to that for 12 months post-transfer. Results 40 YP were transitioned from paediatric to adult diabetes service over the 2 year period. The median age at transfer was 17.9 years. 90% had a key worker at transition. 78% attended the joint transfer clinic and 80% attended the first clinic post-handover. However only 28% had their first appointment within 3–4 months post-transfer. In total 63% were seen within 6 months of transfer. Median HbA1c was 77 mmol/mol post-transfer compared to 66 mmol/mol in 12 months preceding the transfer. Only 30% YP attended 3 or more YP Clinics compared to 75% in the pre-transfer period. 40% missed their annual review in YP Clinic. There was no significant difference in the incidence of diabetes related complications or hospital admissions. The YP Clinics had significantly less dietetic support and no psychology support. Conclusion The metabolic control worsened, and the clinic attendance rate reduced post-transition. However, there was no change in diabetes related acute or chronic complications. This audit showed challenges faced by the YP diabetes team in terms of clinic capacity and lack of access to specialist service like exercise and psychology. The audit helped in developing action plans to address and re-design the elements of current transitional service.