Introduction: Youth-onset type 2 diabetes is an emerging public health crisis with a more aggressive phenotype than both adult-onset type 2 and child-onset type 1 diabetes. Family-focused, lifestyle intervention provided by a multidisciplinary team is central to effective management. Group clinics were introduced for all paediatric patients with type 2 diabetes. A service evaluation assessed the clinical impact and effectiveness of this innovative approach.
Methods: All patients, aged 1117 years, with type 2 diabetes were offered four group clinics instead of individual appointments, over a 1-year period. There were 12 participants and all immediate family were encouraged to attend. Clinic consisted of routine biomedical measurements, a 1-h group education session and a 10-min individual review. HbA1c, waist circumference and age-gender related BMI centile were measured at each appointment. Patient and parent satisfaction was assessed using mixed-methods questionnaires and attendance rates analysed.
Results: Complete HbA1c data (n =11) demonstrated a statistically insignificant rise (P = 0.53). Median HbA1c increased from 44 mmol/mol to 48 mmol/mol over the 1-year. Age-gender related BMI remained static on the 99th centile. Waist circumference data (n = 8) showed a statistically insignificant rise (P = 0.09). Combined patient/parent Likert-scale feedback was positive on all aspects of group clinic: structure, experience, content and lifestyle changes. 92% of respondents would recommend group clinic, however 54% would prefer an individual appointment. Attendance rates were 59.6%, compared to 78.7% for the previous year of individual appointments (P = 0.127). No patient attended all four appointments and an inverse correlation was identified between length of diagnosis and attendance rates.
Conclusions: There was no statistically significant rise is HbA1c or waist circumference. Extrinsic factors such as increased insulin resistance and other challenges of adolescence rather than clinic approach may have prevented improvement. Poor attendance may also have limited the impact of the group clinic. Questionnaire responses were predominantly positive towards the group clinic and participants reported learning more nonetheless, most would prefer individual appointments. Overall, the group clinic delivered increased multidisciplinary, family focussed, lifestyle intervention and peer support, without increasing workload or having a statistically significant negative impact on biomedical outcomes.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes