Endocrine Abstracts

There is a National drive to improve care and outcomes for CYP with T2D in recognition of the aggressive nature of early onset T2D¹ and an 88% increase in numbers receiving care in paediatric services from 201920 to 2023/24^2. The NHSE Diabetes Programme, Core20Plus5 and National CYP Diabetes Network (NCYPDN) priorities are in alignment and have sought to strengthen healthcare professional competencies in managing T2D, bring parity of care with T1D, and reduce health inequalities. A task and finish group from NCYPDN T2D produced a FYOC Pathway to assist Paediatric Diabetes Units (PDUs) to implement holistic support for CYP in line with ACDC³ and NICE⁴ guidance. This comprehensive framework promotes a mindset shift utilising admission at diagnosis to convey severity of T2D in CYP to families, complete timely screening, understand social context and vulnerability factors, formulate a culturally tailored plan and identify risk to signpost family members. A frequent outpatient contact schedule is proposed, adaptable to local resources and circumstances. Intensive support in the initial stages is key with focus on dietetic and psychology input to encourage remission and engagement. The Pathway includes supporting evidence and rationale. It links to toolkits on obesity, use of appropriate language and understanding barriers. Development was informed by the NCYPDN T1 FYOC Pathway, existing T2 guidelines developed by other PDUs during 2022-24, and Sheffield Children’s Hospital pilot FYOC T2 Pathway and 2 year audit results. NCYPDN members were consulted on key components via a T2 Working Group Survey, and a separate live Study Day poll (over 350 delegates). Respondents endorsed the value of admission at diagnosis and CGM for education. The Pathway is deliberately aspirational as a catalyst for quality improvement given poor essential care process completion and outcomes, and to be a lever with commissioners. It will be reviewed in 2027 incorporating learning from the NHSE Complication from Excess Weight pilots, PDU rollout and other T2D service development initiatives.

1. Long-Term Complications in Youth-Onset Type 2 Diabetes. TODAY study Group. N Engl J Med 2021;385:416-426.2. NPDA T2 diabetes Spotlight report 2023/24.3. ACDC T2 guidelines 2023.4. NICE NG18