Endocrine Abstracts

Background: Young people with diabetes often experience a drop in clinic attendance during the transition from paediatric to adult services. This group is particularly vulnerable to disengagement, resulting in poor glycaemic control and long-term complications. In 2021, a young adult diabetes clinic was established at University Hospital Lewisham to address this need. However, initial data revealed a high mean DNA (Did Not Attend) rate of 48.05%. The service was notably under-resourced, lacking a psychologist, youth worker, or dietitian.

Aim: To reduce the DNA rate by at least 50% (target ≤ 24%) and assess the impact on glycaemic outcomes (HbA1c levels).

Methods: This quality improvement (QI) project implemented low-cost, person-centred interventions:

• Tailored appointment reminders: letters, texts, and calls at 7 and 2 days pre-appointment

• Telephone consultations for non-attenders

• Joint appointments with the transition CNS, Diabetes nurse, and consultant

• Non-judgemental, supportive clinic environment focused on the individual, not just diabetes

• DNA letters written directly to patients in a personalised and caring tone

Results: Over a 3-year period (2021–2024), the mean DNA rate was reduced from 48.05% to 10.9%, exceeding the original target. In parallel, patients who attended at least two consecutive appointments showed a median HbA1c reduction of 13 mmol/mol (n = 80), reflecting improved diabetes engagement and management. These improvements occurred without additional staffing or funding, utilising existing team resources more effectively. In addition, the HbA1C reduction was greatest in people who had HbA1C of >64 mmol/mol during transition from paediatrics, with a mean reduction of 12.6 mmol/mol by Wilcoxin test (P <.002).

Conclusion: In the context of significant resource limitations, meaningful reductions in DNA rates and improvements in HbA1c can be achieved through personalised, relationship-focused approaches. By reorienting clinic culture to be more youth-centred and supportive, services can better engage this at-risk group.