Endocrine Abstracts

Background: Children and young people (CYP) with youth-onset type 2 diabetes mellitus (T2DM) are at high risk of developing early complications, leading to increased morbidity and mortality during their most productive years. Due to limited paediatric-specific research, national guidelines aim to standardise care, though implementation and outcomes remain variable. We evaluated local adherence to the paediatric T2DM guideline and assessed changes in clinical outcomes before and after implementation.

Methods: 15 CYP with T2DM were included in a retrospective audit covering two time periods: pre-guideline (April 2023–March 2024) and post-guideline implementation (April 2024–March 2025). Data were extracted from electronic records (Patient Centre, LEPRES, EMIS) and laboratory systems (ICE). Clinical outcomes, guideline adherence, and comorbidity prevalence were compared using Microsoft Excel for analysis.

Results: All patients diagnosed after January 2024 were admitted as per guideline recommendations, except one due to mental health concerns. HbA1c monitoring improved from 20% (2/10) pre-guideline to 53.3% (8/15) post-guideline. Of the 8 patients with regular HbA1c monitoring, 5 showed a reduction in mean HbA1c. Patients diagnosed after guideline implementation had more sustained improvements in glycaemic control. Two patients with HbA1c >69.4 mmol/mol were commenced on combination therapy. All patients received glucose monitoring equipment and were offered multidisciplinary team (MDT) input at diagnosis and annually; 87% (13/15) engaged. Annual psychological screening was completed in 13/15 patients, with 5 receiving targeted psychological support. Weight targets were not achieved in any patient; however, 47% (7/15) achieved a BMI reduction (mean -0.84), and 47% had a Z-score reduction (mean -0.14). Comorbidities included non-alcoholic fatty liver disease (53%) and dyslipidaemia (47%). Two patients developed new complications during the post-guideline period despite having no complications at diagnosis.

Conclusions: Implementation of a structured paediatric T2DM guideline resulted in improved monitoring and glycaemic outcomes. Positive trends in BMI and psychological engagement were observed. These findings support the ongoing use of standardised pathways and MDT input to enhance outcomes in CYP with T2DM, though challenges in weight management and complication prevention remain.