Type 1 diabetes management and hospitalisation in the over 25's at an Australian outer urban diabetes clinic

Shivani Patel, Celine Farkash, David Simmons

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Abstract

Aims To describe clinic management and referral pathways among adults with type 1 diabetes (T1D) aged > 25 years attending a public outpatient diabetes service. Methods Retrospective cohort study of people with T1D aged > 25 years seen by endocrinologists in one Australian urban public outpatient in 2017. Electronic and paper medical records were reviewed using a dataset adapted from the UK National Institute for Health and Care Excellence 2015 guidelines. Results Among the 111 people with T1D (mean age 41 +/- 13 years, 55% men, mean body mass index 27.1 +/- 5.6 kg/m(2)), mean HbA1c was 8.1 +/- 1.9% (66 +/- 19 mmol/mol) (lower than the Australian National Diabetes Audit: 8.5%/69 mmol/mol) with 25.5% meeting the guideline target of < 53 mmol/mol (7.0%). Most people had seen a diabetes educator (80.2%) or dietitian (73.0%) and had complication screening. Complication rates were high (nephropathy 20.4%, retinopathy 27.4%, peripheral neuropathy 30.1%, ischaemic heart disease/acute infarction 10.5%). Overall, 27% of referrals occurred following an acute inpatient admission or emergency department presentation and 13% for management of diabetes in pregnancy. Conclusions A high proportion of people with T1D accessed public specialist care either during pregnancy or after a largely avoidable acute glycaemia-related hospital presentation. Subsequent care was in line with national specialist standards. This area has a "wait for acute event" rather than "complication prevention" model of care, associated with under-referral to the local multidisciplinary specialist service. Understanding how widespread this model of care is, and ways to reduce its prevalence, are urgently required.
Original languageEnglish
Article number143
Number of pages10
JournalBMC Endocrine Disorders
Volume22
Issue number1
DOIs
Publication statusPublished - 2022

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