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 implementation of a pathway addressing the complexity within our population.

Our diabetes service, based in a socially deprived and culturally diverse borough of London, currently cares for (7/171) T2DM patients.

The mean age of diagnosis was 12.7 years. Four are male. Five are from South Asian backgrounds and two identified Black British. Five are from low socioeconomic groups.

The cohort is further characterised by a strong family history of type 2 diabetes (n=5). There is a high prevalence of obesity (n=6) severe obesity (n=5), overweight (n=1).

Co-morbidities include: hypertension (n=1) high cholesterol (n=1) raised albumin: creatinine ratio (n=1) NAFLD on liver ultrasound (n=3) features of OSA (n=1)

Other complexities identified included neurodiversity (n=2), mental health issues (n=2), lack of engagement with healthcare (n=2) reduced school attendance (n=1), home schooling (n=1) living under special guardianship (n=1), safeguarding concerns (n=1)

None had reduced weight by 5% at 3 months or 10% at 1 year from diagnosis.

Pathway implementation incorporated a specialist dietician as the keyworker for all T2DM patients and personalised ‘goal development.’  

Following implementation there was an observed increase in the use of CGM technology and pharmaceutical intensification amongst patients. Prior to pathway use one patient was on lifestyle management only. Afterwards all patients were taking at least one medication. Several had reported side-effects resulting in non-compliance.

Of the 7 patients sensor use increased from five to six individuals. The number prescribed metformin increased from five to six, those using long acting insulin from two to three.

Use of GLP-21 receptor agonists increased notably from one to four patients, while short-acting insulin use remained unchanged (n=1.)

There was also an increased number of Diabetes team contacts (mean=9) over the last 5 months.

Three specialist referrals were recorded post pathway implementation (safeguarding, renal and liver services).

This work highlights the level of complexity of T2DM. Pathway implementation increased utilisation of sensor technology and GLP1 receptor agonists alongside more assertive management.