Outcome of a young adolescent diabetes transition clinic in an inner city ethnic population in Birmingham: an audit
J Cutler, B Munir, L Hudson, J Ashton, S Holmes, M Plunkett & P De
Introduction: Management of adolescent diabetes is challenging due to a complex interplay of physiological and psychological factors.
Aims: To audit the outcome of our local hospital adolescent diabetes clinic.
Method: Adolescents aged 1624 years are seen by our multi-disciplinary team (adult and paediatric diabetes consultant, diabetes specialist nurses and a dietician) every 4 months after transfer from paediatric service. We looked at the clinic records and electronic data of 56 patients over 5 years (20062010).
Results: Forty-seven had TIDM, eight T2DM and one possible MODY (31 males, 25 females). Mean age 20 (range 1726) years and average diabetes duration 9.5 years (Asian 28, Afro-Caribbean 9, Caucasian 16, African 3).
Seventeen patients had undergone structured education (DAFNE) and four are on waiting list. Four had 1:1 carbohydrate counting sessions.
Two patients had coeliac disease, two used recreational drugs and eight took alcohol. Four patients developed retinopathy and five microalbuminuria over these 5 years. Mean HbA1c in 2006 was 9.2% and in 2010 was 9.6%. HbA1c improved in 15/56 (27%) patients and was static in eight patients. There were 40 patients in 2006 on multi-dose insulin injection, increasing to 52 by 2010. There was a 44% (nine in 2008, five in 2010) and 35% (35 in 2007, 23 in 2010) reduction in DKA and hypoglycemia related hospital admissions respectively. Clinic attendance rates improved from 68 to 79%. User questionnaire results show significant patient satisfaction.
Conclusions: Our ethnically mixed adolescent diabetes clinic remains a big challenge. We have started to convert more patients to multi-dose insulin injections and enrol into structured education (DAFNE). Empowerment and clinic attendance is getting better, DKA and hypoglycaemia admissions have fallen through more frequent diabetes specialist nurse contact and support (by e-mails, mobile text messaging, drop-in clinics) hopefully, we shall see concomitant improvements in HbA1c in future.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.