Endocrine Abstracts

Introduction: The first year following diagnosis of Type 1 diabetes is a crucial period for children and young people (CYP), establishing the foundation for long-term glycaemic control and self-management. Early optimisation of glucose control is associated with reduced risk of diabetes-related complications in later life.

Objectives: To assess the impact of a standardised First Year of Care (FYOC) pathway on clinical and process outcomes in CYP newly diagnosed with Type 1 diabetes.

Methods: This retrospective audit included CYP with new-onset Type 1 diabetes across six NHS Trusts. Data were collected for two periods: pre-FYOC (April 2021–March 2022) and post-FYOC (April 2023–March 2024). Outcomes included proportion with HbA1c <48 mmol/mol at 4–6 and 9–12 months, time in range (TIR, 4–10 mmol/l) >70% at 6–12 months, psychology review within 2–6 weeks, and completion of Level 3 carbohydrate counting. Qualitative data was collected from each organisation.

Results: There were 247 CYP in the pre-FYOC group and 198 post-FYOC. At 6 months, 36% of the post-FYOC group had HbA1c <48 mmol/mol vs 27% pre-FYOC (P = 0.009). At 12 months, 41% of the post-FYOC group had TIR >70% vs 32% pre-FYOC (P <.001). By 12 months, 60% of CYP in the post-FYOC group were using hybrid closed loop (HCL) systems. HCL use was highest in the 0–4 year group (73%) but HbA1c <48 mmol/mol was lower in this group (20%) compared to 42% in 15–19 year olds. Qualitative data highlighted challenges in timely psychology access and identifying CYP in their first year when attending general clinic.

Conclusions: The FYOC pathway improved clinical and care process outcomes in newly diagnosed CYP. NICE TA943, implemented in December 2023, facilitated HCL access nationally; the FYOC pathway supported high uptake within the first year. Successful implementation requires clearly defined local processes for each CYP and a well-resourced multidisciplinary team, including psychology input.