Endocrine Abstracts

Introduction: Young people with type 1 diabetes (T1DM) face great challenges in managing their disease. Puberty poses strains on glycaemic control. Transferring from paediatric to adult diabetic services is another obstacle. The study aims to evaluate our local transition and transfer service provision and monitoring of the young people’s HbA1c control during this challenging period.

Methods: T1DM patients transferred from our hospital’s paediatric to adult diabetic services from 1/9/10 to 31/8/14 were identified. Those who left adult service within 2 years following transfer were excluded. Case notes and electronic lab records were analysed.

Results: Over 4 years, 21 patients were transferred from paediatric to adult services. 4 moved out of region within 2 years of transfer, leaving 17 patients in the study. 94% (16/17) received transition care. The mean age of transition was 17.9 years (range 15.8–19.4) while the mean age of transfer to adult care was 19.2 years (range 17–20.9). Thus, the mean duration in transition was only 1.3 years. The clinic attendance rate also dropped significantly from 82.7% while in transition to 71.3% after transfer to adult care (P=0.037). Only 58.8% patients were offered their first adult clinic within 3 months after transfer. Overall, first adult clinics were attended at a mean of 4.8 months (range 3–9) post-transfer. Their mean HbA1c was 84.1 mmol/mol before transition and peaked at 89.6 mmol/mol after 1 year in adult care (~20.2 years), before significantly improving (P=0.01) to 83.7 mmol/mol 2 years after transfer (~21.2 years).

Conclusions: HbA1c worsened first year after transfer, peaking at an age and level that is later and higher than literature reports, thus exposing these young people to a longer period of poor glycaemic control. This study has identified areas for improvement: start transition clinic at an earlier age to allow longer transition and reduce gap between last transition and first adult clinics for continuity of care.