Adult Diabetes Services Research Articles

The transition to the adult diabetes service: step-by-step support

The transition of young type 1 diabetic patients from pediatrics to adult diabetes services is a delicate stage, with the risk of a break in the care pathway. These adolescents are apprehensive about leaving the pediatric sector, and often experience the change as an abandonment. It is therefore vital to prepare them and support them during and after the transfer, in order to improve their experience.

Transition between paediatric and adult diabetes healthcare services: An online global survey of healthcare professionals’ experiences and perceptions

IntroductionYouth with diabetes should transition from paediatric to adult diabetes services in a deliberate, organized and cooperative way. We sought to identify healthcare professionals’ (HCPs) experiences and perceptions around transition readiness planning, policies and procedures, and the actual transfer to adult services. MethodsData were collected via an online global survey (seven language options), broadly advertised by the International Society for Pediatric and Adolescent Diabetes (ISPAD), European Association for the Study of Diabetes (EASD), team members and partners, via newsletters, websites, e-mails and social media. ResultsRespondents (n = 372) were mainly physicians (74.5 %), practicing in government funded (59.4 %), paediatric (54.0 %), metropolitan settings (85.8 %) in Europe (44.9 %); 37.1 % in low and middle-income countries (LMICs). Few centers used a transition readiness checklist (32.8 %), provided written transition information (29.6 %), or had a dedicated staff member (23.7 %). Similarly, few involved a psychologist (25.8 %), had combined (35.2 %) or transition/young person-only clinics (34.9 %), or a structured transition education program (22.6 %); 49.8 % advised youth to use technology to assist the transfer.Most (91.9 %) respondents reported barriers in offering a good transition experience. Proportionally, more respondents from LMICs prioritised more funding (p = 0.01), a structured protocol (p < 0.001) and education (p < 0.001). ConclusionHCPs’ experiences and perceptions related to transition vary widely. There is a pressing need for an international consensus transition guideline.

1957-LB: Transition between Pediatric and Adult Diabetes Services—The Experiences and Perceptions of Health Care Professionals Worldwide

1957-LB: Transition between Pediatric and Adult Diabetes Services—The Experiences and Perceptions of Health Care Professionals Worldwide

ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes in adolescence.

ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes in adolescence.

Understanding a young adult diabetes service's accessibility: have virtual appointments helped?

AbstractDiabetes mellitus is characterised by hyperglycaemia, requiring strict management regimens to avoid associated health complications. Diagnosis and/or management of diabetes during young adulthood can be particularly challenging, potentially contributing to significant psychological distress and struggles with management, culminating in poor physical and mental health outcomes.This service evaluation sought feedback from young adult patients (19–25 years old) on diabetes service accessibility and to understand the impact of offering virtual appointments during the COVID‐19 pandemic.All young adult patients (n=101) were invited to complete an online questionnaire about their experience of service accessibility and offered the opportunity to discuss their feedback in a telephone interview. Data were collected from 15 patients.Analysis using content and thematic analyses revealed three main themes regarding service accessibility: practical barriers, psychological barriers, and patients’ relationship with the diabetes team.Recommendations are made for several service developments concerning appointment scheduling, appointment set‐up, and developments around service provision more widely. Further research is needed to gain a wider range of feedback to inform future developments and should prioritise patient involvement to increase patient response rate. Copyright © 2022 John Wiley &amp; Sons.

Eight-Year Retrospective Study of Young Adults in a Diabetes Transition Clinic.

The transition of people from paediatric to adult diabetes services is associated with worsening glycaemia and increased diabetes-related hospitalisation. This study compared the clinical characteristics of those with and without mental health conditions among attenders at a diabetes young adult clinic diabetes before and after changes in service delivery. Retrospective audit of 200 people with diabetes attending a Sydney public hospital over eight years corresponding to the period before (2012–2016) and after (2017–2018) restructuring of a clinic for young adults aged 16–25 years. Characteristics of those with and without mental health conditions (depression, anxiety, diabetes related distress, eating disorders), were compared. Among clinic attenders (type 1 diabetes n = 184, 83.2%), 40.5% (n = 89) had a mental health condition particularly, depression (n = 57, 64%), which was higher among Indigenous than non-Indigenous people (5.6% vs. 0.8%, p = 0.031) but similar between diabetes type. Over eight years, those with, compared with those without a mental health condition had higher haemoglobin A1c (HbA1c) at the last visit (9.4% (79 mmol/mol) vs. 8.7% (71 mmol/mol), p = 0.027), the proportion with diabetic ketoacidosis (DKA 60.7% vs. 42.7%, p = 0.009), smoking (38.4 vs. 13.6%, p = 0.009), retinopathy (9.0 vs. 2.3%, p = 0.025), multiple DKAs (28.4 vs. 16.0%, p = 0.031) were significantly higher. Having a mental health condition was associated with 2.02 (95% confidence intervals 1.1–3.7) fold increased risk of HbA1c ≥9.0% (75 mmol/mol). Changes to the clinic were not associated with improvements in mental health condition (39.0% vs. 32.4%, p = 0.096). In conclusion, we found that mental health conditions, particularly depression, are common in this population and are associated with diabetes complications. Diabetes type and clinic changes did not affect the reported mental health conditions. Additional strategies including having an in-house psychologist are required to reduce complication risks among those with mental health conditions.

HbA1c and attendance before and after transition to adult diabetes service: a transition audit

HbA1c and attendance before and after transition to adult diabetes service: a transition audit

ABCD position statement on risk stratification of adult patients with diabetes during COVID-19 pandemic

At the time of submission of this manuscript, the COVID-19 pandemic had cost nearly 60,000 lives in the UK. This number currently stands at over 120,000 deaths. A high proportion (one third) of these lived with diabetes. The huge acute and emergency medicine effort to support people with COVID-19 has had a major knock-on impact on the delivery of routine clinical care, especially for long-term conditions like diabetes.Challenges to the delivery of diabetes services during this period include a reduction in medical and nursing staff, limitations placed by social distancing on physical clinical space, and balancing virtual vs face-to-face care. There is a need to re-group and re-organise how we deliver routine out-patient adult diabetes services during the ongoing COVID-19 pandemic. We offer some suggestions for how patients can be stratified into red (urgent), amber (priority) and green (routine) follow up with suggestions of how often people should be seen. We also offer recommendation on how we can identify those at highest risk and try and minimise the long- term impact of COVID on diabetes careDuring the COVID pandemic we have seen things happen in days that previously took years. The restart of diabetes services has triggered a more widespread use of virtual consultations and data management systems, but also offers an opportunity for more joined-up and cohesive working between primary and specialist care. While we do our best to keep our patients and colleagues safe, this pandemic is already proving to be a catalyst for change, accelerating the appropriate use of technology in diabetes care and implementing innovative solutions. To achieve this aspiration, further work – currently led by the Association of British Clinical Diabetologists in collaboration with Diabetes UK and the Primary Care Diabetes Society – to make recommendations on future proofing diabetes care in UK is in progress.

Health care professionals talking: Are services for young adults with type 1 diabetes fit for purpose?

The challenges of becoming a mature adult may distract young adults with type 1 diabetes from disease self-management, increasing risks for premature morbidity and mortality. Despite the importance of young adults with type 1 diabetes engaging with preventative diabetes-related health care services, few studies report health care professionals' experiences and perceptions of the support that is available, including during the period of transition. This study sought to determine these factors across diverse contexts in one health jurisdiction. This qualitative study was undertaken in New South Wales, Australia. Recruitment was based on a snowball sampling technique, which began with members of an established diabetes service group. Data were collected by individual semistructured interviews with 16 health care professionals, most of whom were registered nurses (75%), working at differing levels of expertise and responsibility across metropolitan and regional/rural areas. Data were analysed using thematic analyses. Participants overwhelmingly recognized the time and care needed to support young adults with type 1 diabetes to prepare them for adult self-management and to work with adult diabetes services, and the importance of youth-friendly services. They reported shortfalls and inequitous distribution in services for these young adults. Two themes, addressing the present and future possibilities, expressed their perceptions of services for this population: working with what is available and mapping a route to better services. Findings identify opportunities for development in the planning and provision of specialist multidisciplinary health care support for this population. New ideas are needed for policy and practice innovation and for the infrastructure to facilitate this, to ensure that young adults with type 1 diabetes have access to consistent and coordinated diabetes health care services, particularly in nonmetropolitan settings.

Microvascular diabetes complications in a specialist young adult diabetes service.

The provision of medical care to young adults with type 1 diabetes mellitus is challenging. The aim of this study was to determine the rates of microvascular complications and their progression among patients with type 1 diabetes mellitus attending a specialist young adult diabetes service in Ireland. A retrospective review of 62 (male 56.5%) patients with type 1 diabetes mellitus attending the young adult diabetes service at our institution was undertaken. Data was recorded across two time points, clinic registration and at 5years following initial contact. The mean ± SD age at first attendance was 17.4 ± 2.0years. Mean ± SD duration of diabetes was 6.3 ± 3.9years with most patients treated using multiple daily insulin injections (75.8%). diabetic retinopathy rate at first attendance was 17.7% and after 5years was 37.1% (p = 0.003). The majority of cases were background retinopathy. The prevalence of diabetic kidney disease was 6.4% and this remained unchanged at follow-up. Mean ± SD HbA1c improved from 76.1 ± 22.4mmol/mol (9.1 ± 4.2%) to 69.1 ± 14.9mmol/mol (8.5 ± 3.5%), p = 0.044. Duration of diabetes was the only clinical variable associated with retinopathy risk at 5years on multiple regression analysis (p = 0.037). Diabetic retinopathy is prevalent in young adults with type 1 diabetes attending specialist secondary care diabetes services. Duration of diabetes was the strongest determinant of retinopathy risk.

Diabetes medication pharmacology

Diabetes medication pharmacology

Group clinics for young adults with diabetes in an ethnically diverse, socioeconomically deprived setting (TOGETHER study): protocol for a realist review, co-design and mixed methods, participatory evaluation of a new care model

IntroductionYoung adults with diabetes often report dissatisfaction with care and have poor diabetes-related health outcomes. As diabetes prevalence continues to rise, group-based care could provide a sustainable alternative to traditional...

Transition of care for adolescents from paediatric services to adult health services.

Background There is evidence that the process of transition from paediatric (child) to adult health services is often associated with deterioration in the health of adolescents with chronic conditions.Transitional care is the term used to describe services that seek to bridge this care gap. It has been defined as ‘the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centred to adult-oriented health care systems’. In order to develop appropriate services for adolescents, evidence of what works and what factors act as barriers and facilitators of effective interventions is needed. Objectives To evaluate the effectiveness of interventions designed to improve the transition of care for adolescents from paediatric to adult health services. Search methods We searched The Cochrane Central Register of Controlled Trials 2015, Issue 1, (including the Cochrane Effective Practice and Organisation of Care Group Specialised Register), MEDLINE, EMBASE, PsycINFO, and Web of Knowledge to 19 June 2015. We also searched reference lists of included studies and relevant reviews, and contacted experts and study authors for additional studies. Selection criteria We considered randomised controlled trials (RCTs), controlled before- and after-studies (CBAs), and interrupted time-series studies (ITSs) that evaluated the effectiveness of any intervention (care model or clinical pathway), that aimed to improve the transition of care for adolescents from paediatric to adult health services. We considered adolescents with any chronic condition that required ongoing clinical care, who were leaving paediatric services and going on to receive services in adult healthcare units, and their families. Participating providers included all health professionals responsible for the care of young people.

The way forward at Diabetes UK

Introduction To start with a brief introduction, I succeeded Barbara Young as Chief Executive of Diabetes UK last September, arriving from breast cancer research and support charity, Breakthrough Breast Cancer, where I had worked for eight years, initially as Director of Fundraising and then as Chief Executive, leading charity into a merger with a smaller breast cancer charity to form Breast Cancer Now. Before that, I held an interim role at JDRF, which marked my entry into health sector. Since arriving at Diabetes UK, I have understood immense challenges of diabetes, at an individual and system level, but also unique opportunity offered by broader recognition of these challenges by politicians, health service leaders, healthcare professionals, people with diabetes, public and media. Our recent news release that numbers of people with diabetes in UK population has topped 4 million for first time attracted huge attention. Public debate around addressing our obesogenic environment appears to be coalescing to a consensus that now is time to take action. The National Diabetes Prevention Programme should be acknowledged as a first nation-wide investment in applying evidence to prevent growing tide of Type 2 diabetes and it is right that Diabetes UK is central in driving this work forward. But there is much more yet to achieve. The findings of November’s National Audit Office report on adult diabetes services, re-emphasised in a Public Accounts Committee’s review earlier this year, make for a sobering read; whilst there's been progress in lowering additional risk of death from diabetes (in truth, a change which has come about as a result of improvements in delivering nine recommended care processes and achieving three treatment standards in late 90s and early 2000s), there is little progress reported in other key areas since initial report of 2012. In words of report itself significant geographic variations persist in quality of care for people with diabetes and in their outcomes..., groups of diabetes patients, such as patients with Type 1 diabetes, receive worse routine care and have poorer outcomes...., the percentage of hospital beds occupied by diabetes patients is increasing but levels of diabetes specialist staff have not changed..., current payment mechanisms within NHS are not offering incentives to integrate diabetes care ...., few people with diabetes are recorded as receiving patient education.... The more recent National Diabetes Audit looks set to report improved blood pressure across Type 1 and Type 2, but highlights lowest level of completion of eight care processes, since at least 2009, at 38.7% and 58.7% for Type 1 and Type 2 respectively. I know that these issues concern us all hugely; I feel strongly that Diabetes UK’s role, alongside highlighting problems, is to work in partnership with specialists and others in system, to develop effective solutions that help to change picture for diabetes care. In this article I want to highlight some of key challenges that stand out from my initial conversations with diabetologists and to outline some of work that can help us, together, to grasp opportunities to improve diabetes care.

Reproductive health knowledge, attitudes and beliefs in young women with type 1 diabetes mellitus aged 15 – 25 years attending a tertiary centre multidisciplinary transition clinic: A descriptive study

To assess issues related to the existing reproductive health knowledge, attitudes and beliefs in 15 – 25 year old young women with type 1 diabetes mellitus (T1DM), we administered a questionnaire as sexually active adolescents with T1DM are at high risk of unplanned pregnancies and reproductive complications. Glycaemic control during adolescence is recognised as being poorer than during any other life stage. Periconceptional poor glycaemic control is associated with increased incidence of congenital malformations. This is a descriptive study in females aged 15 – 25 years attending our Young Adult Diabetes Service (YADS) clinic, a transition clinic at Monash Medical Centre, a conception to end of life tertiary health facility. Our study was undertaken between June 2011 and June 2013, when there were 173 eligible young women on our YADS clinic database. Data was collected on a cross-sectional basis from a web-based questionnaire on a sample of 100 female adolescents who provided consent to participate (58% of those eligible), using a modified reproductive health attitudes and behaviour (RHAB) questionnaire [1]. Almost half (48%) of respondents were sexually active, with a mean age of sexual debut of 16.9±1.8years (range 13 – 21yrs). Mean HbA1c was 8.9±1.6%. HbA1C in non participants was significantly higher (9.2±1.8%), although responders and non-responders were comparable on age and SES. Responses to questions related to their personal concerns about their future health risks, revealed that respondents perceived their risk and level of concern of unplanned pregnancies (18.7%) and STDs (8.7%), to be much lower than those of weight gain (59.3%) and blindness (57.1%). Despite high perceived benefits of prepregnancy counselling (PC) (78%), low PC delivery rates were reported by study participants (15%), although review of clinic check lists revealed documentation that 34% of study participants had received PC. Diabetic Nurse Educators (DNEs) were perceived to be the most useful source of health information (81% of respondents). We support recommendations of the National Health and Medical Research (NHMRC - 2011) that young adolescents need developmentally appropriate information from commencement of puberty, with a sensitive, proactive, preventative approach before these young women become sexually active, to enable them to make informed choices regarding reproductive health. However, engaging adolescent girls with T1DM to provide effective provision of such information remains challenging, even in an age appropriate specialised clinic setting.

A pilot randomized controlled trial of a post-discharge program to support emerging adults with type 1 diabetes mellitus transition from pediatric to adult care.

There is a paucity of randomized controlled trials (RCT) examining transition from pediatric to adult care in type 1 diabetes mellitus (T1DM). This study aimed to determine if transition in T1DM is more effective with a comprehensive transition program (CTP) compared with standard clinical practice (SCP). This RCT recruited as young people left pediatric diabetes services. The trial co-ordinator provided CTP participants with standardized telephone communication support at week 1, and 3, 6, and 12 months post-discharge from pediatric care. SCP participants were briefly contacted at 6 and 12 months post-discharge to confirm transfer status; they received no other post-discharge contact as per usual practice. At 12 months, the primary outcomes were engagement and retention in the adult service and secondary outcomes included hemoglobin A1c (HbA1c), diabetes-related hospitalizations, microvascular complication appearance, and global self-worth. Most CTP participants (11/14) and all SCP (12/12) participants (P = 0.2) transferred to an adult diabetes service; the median time to transfer was 14-15 wk. Overall, participants' frequency of adult diabetes service visits was sub-optimal but their retention in adult care was high. The only group difference was a higher HbA1c at baseline and follow-up in the CTP group. However, a general linear model found that follow-up HbA1c increased by 1.2% for each percentage increase in baseline HbA1c [95% confidence interval (0.4, 1.9; P = 0.01)], independent of treatment group. Despite the challenges in recruiting adequate numbers, these findings provide valuable insights for future T1DM transition RCTs that are needed to build a more solid evidence-base in this field.

Factors determining diabetes care outcomes in patients with type 1 diabetes after transition from pediatric to adult health care: a systematic review

Executive summary Background The transition of young adults with type 1 diabetes from pediatric to adult health care usually takes place at the end of secondary schooling, at a time when they are also experiencing multiple life transitions. Diabetes self-care management will often be of low priority for young people as they adjust to new routines involved with further study, employment and relationships. Failure to transition successfully may result in loss to medical follow-up, deterioration in diabetes control and development of short and long term diabetes complications. Objectives The primary focus of this systematic review was to identify the best available evidence of factors that determine diabetes care outcomes for young adults with type 1 diabetes after transition from pediatric to adult health care services. Inclusion criteria Types of participants Studies involving people aged 15-19 years inclusive with a diagnosis of type 1 diabetes who have transitioned from pediatric to adult health care services. Types of intervention(s) Any intervention which identified factors that influenced the transition of young people with type 1 diabetes from pediatric to adult health care. Types of studies All clustered trials, descriptive studies, pre-and post-test studies, and other designs with a control group and case studies evaluating factors which influence the transition from pediatric to adult health care of patients with type 1 diabetes were included in the review. Types of outcomes Primary outcomes: Diabetes control as measured by HbA1c at follow-up, loss to follow-up, adherence to insulin therapy, incidence of hospital admission for acute complications, and frequency and regularity of clinic attendance Secondary outcomes: Uptake of screening for long term diabetes complications, cost effectiveness of intervention, health-related quality of life and patient satisfaction Search strategy Seven databases were searched and the reference list of all included studies was searched for additional studies. There was no time limitation to the search. Methodological quality The methodological quality of eligible trials was assessed independently by two reviewers using the Joanna Briggs Institute (JBI) quality assessment tool. Data collection Data extraction from the included trials was undertaken and summarized independently by two reviewers using the JBI data extraction tool which was modified in order to extract detailed data from the study. Data synthesis Where data were available, it has been pooled and presented as a forest plot in the review results. Studies with textual data results or where synthesis is inappropriate are presented as a narrative summary. Results Forty-one studies that potentially met the criteria for inclusion in the review were identified by the search strategy, of which 13 met the inclusion criteria. Factors identified to assist transition in the review studies related to either structured or unstructured interventions. The results of this review demonstrate that when a structured program is in place to assist the transition from pediatric to adult diabetes services, young people are less likely to require hospitalization for acute diabetes complications and more likely to attend appointments at the adult diabetes service. Conclusions The evidence identified from this review is suggestive that a structured transition intervention employing a dedicated health professional to support and coordinate the process is more likely to prevent loss to follow-up, maintain clinic attendance, have a positive impact on diabetes control, reduce hospital admissions, and be a more cost effective and positive experience for patients than an unstructured or usual care model. Implications for practice The unique needs of these patients demand services distinctly different to the general adult patient with diabetes and adult clinicians should take an active role in ensuring follow-up in this vulnerable group. Implications for research Due to the relatively small numbers in this patient cohort one suggestion for future research would be to conduct multi-center randomized controlled trials which may then provide more meaningful evidence of diabetes transition and outcome measures.

Challenges of emerging adulthood-transition from paediatric to adult diabetes.

Diabetes mellitus is a complex condition with far reaching physical, psychological and psychosocial effects. These outcomes can be significant when considering the care of a youth transferring from paediatric through to adult diabetes services. The art of mastering a smooth care transfer is crucial if not pivotal to optimising overall diabetic control. Quite often the nature of consultation varies between the two service providers and the objectives and outcomes will mirror this. The purpose of this review is to analyse the particular challenges and barriers one might expect to encounter when transferring these services over to an adult care provider. Particular emphasis is paid towards the psychological aspects of this delicate period, which needs to be recognised and appreciated appropriately in order to understand the particular plights a young diabetic child will be challenged with. We explore the approaches that can be positively adopted in order to improve the experience for child, parents and also the multi- disciplinary team concerned with the overall delivery of this care. Finally we will close with reflection on the potential areas for future development that will ultimately aim to improve long-term outcomes and experiences of the young adolescent confronted with diabetes as well as the burden of disease and burden of cost of disease.

Carbohydrate counting and insulin dose adjustment group sessions for type 1 diabetes: a pilot of their effectiveness at a primary care diabetes centre

AbstractIt is recommended that a structured group education programme such as DAFNE (Dose Adjustment For Normal Eating) is offered to all adults with type 1 diabetes. Such programmes teach the skills of carbohydrate counting and insulin dose adjustment with the aim of improving glycaemic control (HbA1c) without increasing the risk of hypoglycaemia.South West Essex Community Services adult diabetes service was finding that individuals were not accessing the DAFNE programme for various reasons. A diabetes specialist dietitian and nurse decided to pilot the delivery of two 3‐hour group sessions to teach some of the basic carbohydrate counting and insulin dose adjustment skills.Changes in HbA1c pre‐ and post‐intervention were reported for 68 subjects. The four different intervention arms compared were: those who attended just the carbohydrate counting session (n=14), those who attended both sessions (n=24), those who had attended one or both sessions and then went on to attend DAFNE (n=10), and those who had received no carbohydrate counting education (n=20).Those who had attended one or both of the 3‐hour sessions had a mean and absolute reduction in HbA1c compared with the group that had not received any education, although this was not statistically significant. The group that had attended one or both of the 3‐hour sessions and DAFNE did achieve a statistically significant reduction in HbA1c compared with the group that had not received any education.Despite several identified limitations to the pilot, it was felt that the delivery of the two 3‐hour carbohydrate counting and insulin dose adjustment sessions demonstrated some clinically (if not statistically) significant improvement in HbA1c. Copyright © 2013 John Wiley &amp; Sons.

Factors associated with glycaemic control in Singapore children and young people with diabetes

Data from follow-up studies of DCCT (EDIC) [1,2] and UKPDS [3] suggest that tight glycaemic control in the early years after diagnosis of diabetes may delay the onset and development of diabetes-related complications. This phenomenon of “metabolic memory” [4] is particularly relevant for patients who are diagnosed during childhood and adolescence because of potentially longer lifetime duration of diabetes. We conducted the present study to identify the factors associated with glycaemic control in Singapore children and young people with diabetes. A cross-sectional analysis of data from our Paediatric Diabetes Service database as at the end of 2011 was performed. We included 125 patients (57 male; 46%), age 1 year duration, who had attended clinic at least twice during 2011, and whose mean HbA1c measured at their clinic attendances was either good (HbA1c 10%; Group 2, n=56). The following factors in the two groups were compared: patient characteristics (gender, ethnicity, current age, age at diagnosis, duration of diabetes, type of diabetes, family history); medical treatment prescribed (insulin, oral agents, both); and extent of resource utilization (diabetes clinics, medical social worker (MSW) input, dietician reviews). Patients whose glycaemic control was intermediate (8% ≤ HbA1c ≤ 10%), and those with other types of diabetes (non-T1D and non-T2D), medical co-morbidities, or who had transitioned to the Adult Diabetes Service during 2011, were excluded. Compared to Group 1 (good control) patients, Group 2 (poor control) patients were more likely to be non-Chinese (52% vs 24%; p=0.01) and to have received MSW input (30% vs 9%; p=0.002) and attended more diabetes clinics in 2011 (4.4±1.3 vs 3.5±1.0 times; p<0.001) – see Table 1. Multivariate analyses found that these three factors remained independently predictive of poor glycaemic control. There was no statistically significant difference between the two groups in all the other factors examined. Ethnicity and utilization of healthcare and social services were factors associated with glycaemic control in Singapore children and young people with diabetes. These findings suggest that there are paediatric diabetes patient groups in which the desired outcome was not achieved despite providing higher levels of currently available support. Therefore, we need to devise new ways of improving the management of these at-risk patients.