Endocrine Abstracts

Type 2 diabetes (T2DM) in children and young people (CYP) is an emerging challenge within paediatric diabetes services. We present findings from a local audit and describe the development of a new care pathway addressing the complexity within this population. Our diabetes service, based in a socially deprived and culturally diverse borough of London, currently cares for (8/171) T2DM patients. Five were from South-Asian backgrounds, 2 African/African-Caribbean and 1 Caucasian ethnicity. Six were from low socioeconomic groups. Four were male. The mean age of diagnosis was 12.6 years. Patients were seen in a predominantly T1DM clinic. The cohort is further characterised by a strong family history of diabetes (n = 5), high prevalence of severe obesity (n = 7), neurodiversity (n = 2), and mental health issues (n = 2). There was also poor engagement with care (n = 2), poor school attendance (n = 1), home schooling (n = 1) and one child living under special guardianship. Most patients received key annual NPDA care processes. Retinal screening had lowest completion rate (n = 1). Co-morbidities identified included: acanthosis nigricans (n = 5) hypertension (n = 1) high cholesterol (n = 3) raised albumin: creatinine ratio (n = 1) NAFLD on liver ultrasound (n = 3) features of OSA (n = 1) All had been offered CGM and 6 were using this technology. Treatment regimes varied: Four were prescribed Metformin. Five were taking Insulin. One patient was taking no treatment. One patient was prescribed Dulaglutide. Several had reported side-effects with treatments resulting in non-compliance or deviation from first line therapies. None had reduced weight by 5% at 3 months or 10% at 1 year. In response, we co-developed a new localised care pathway prioritising holistic, personalised, and family-centred care delivered through a strengthened multidisciplinary team (MDT) approach. Key elements include structured education, standardisation of care processes and medication, culturally sensitive communication (e.g. Ramadan considerations) and signposting to local physical activity and weight management services. Re-audit data is being collected and will be available before November 2025. The aim is to improve engagement and use of local resources. This work highlights the level of complexity of T2DM and highlights the importance of context-specific models of care. A localised pathway is essential to improve outcomes for this vulnerable group.