Young adults with Type 1 diabetes: A retrospective observational single-centre study

Abstract

Aims: A retrospective review of clinical outcomes for young adults with Type 1 diabetes from the East Midlands was conducted in 2003. We aimed to explore whether glycaemic control in young adults had improved in 2016. In paediatric diabetes the Best Practice Tariff has been associated with a reduction in HbA1c. Methods: Patients aged 18-25 years with Type 1 diabetes attending Derby Teaching Hospitals were included. Data were collected retrospectively from case notes and computer records on glycaemic control, the prevalence of complications, clinic and structured education attendance. Results: A total of 127 patients were included in this analysis. Mean age of patients was similar between the 2016 and 2003 cohorts (20.9 +/- 2.6 vs 20.3 +/- 2.6 years) but duration of diabetes was less in 2016 (7.9 +/- 5.6 vs 10.0 +/- 5.6 years). Mean HbA1c levels were unchanged between the two cohorts at 80mmol/mol (9.5%) for both. Within the present cohort 4.3% and 12.8% achieved an HbA1c target of < 48mmol/mol (6.5%) and < 58mmol/ mol (7.5%) respectively. The majority used MDI therapy (85%, n = 108), followed by insulin pump therapy (9%, n = 11). Only 6% (n = 4) were on a twice daily mixed insulin. One fifth were DAFNE graduates (20.6%, n = 27). DNA rate was 31.3%. Of those screened, half had retinopathy (48%, n = 42). Conclusion: In contrast to the paediatric population and despite the use of intensified insulin therapy, insulin pumps and DAFNE, glycaemic control in young adults with Type 1 diabetes remains poor. Extension of the Best Practice Tariff to those < 25 years may benefit outcomes in this cohort.