Background: Our Paediatric Diabetes service has a challenging rise in proportion of patients with Type 2 Diabetes Mellitus (T2DM); 8.5% of our current cohort; compared to 3.5% regionally and 2.5% nationally (NPDA 20172018).
Objectives: Establish a T2DM New Diagnosis Pathway and T2DM clinics aiming to achieve HbA1c < 48 mmol/mol for all new patients at 3 months and a year, with 10% weight loss.
Methods: Patients diagnosed with T2DM since November 2018 are admitted for education/ treatment according to the new pathway. Comorbidity screening is undertaken at diagnosis with psychology and dietetic screening of well-being/eating behaviours. Patients have monthly MDT review for the first 3 months with adjustment of treatment, diet/activity prescriptions and agreed goals. Patient outcomes were compared with the preceding 6 patients.
Results: Six patients were newly diagnosed with T2DM (mean HbA1c 78 mmol/mol; previous group mean 54 mmol/mol). HbA1c significantly improved at 3 months for both current and previous patients (mean HbA1c 44 and 42.5 mmol/mol respectively), with no significant difference between groups. However, with the new pathway, a greater proportion achieved HbA1c <48 mmol/mol compared to previous (80% vs 67%). A greater proportion had comorbidity screening at diagnosis, with improved profiling of lipids and sleep assessment (100% vs 67% and 83% vs 0% respectively). In the previous group, 2/6 had evidence of fatty liver disease and dyslipidaemia. In the current group 1/ 5 screened had evidence of sleep disordered breathing. Median BMI Z score SDS was unchanged in the previous group between diagnosis and 6 months (+2.8 SDS). In the current patient group the median had improved to +2.4 SDS from +2.7. Overall however the mean BMI Z score had not changed significantly from diagnosis to 6 months in either group. Additional outcomes included coordinated comorbidity screening, reducing appointment burden. Specialised clinics have facilitated recruitment to clinical trials. Wider impact of the service includes the initiation of young people friendly local gym opening times.
Conclusion: The tailored T2DM pathway and clinics have improved the proportion of patients achieving the target HBA1c at 3 months with a more holistic and streamlined approach.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes