1. Type 1 diabetes management and hospitalisation in the over 25's at an Australian outer urban diabetes clinic.
- Author
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Patel, Shivani, Farkash, Celine, and Simmons, David
- Subjects
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GLYCOSYLATED hemoglobin , *ENDOCRINOLOGISTS , *PERIPHERAL neuropathy , *HOSPITAL emergency services , *MYOCARDIAL ischemia , *TYPE 1 diabetes , *RETROSPECTIVE studies , *ACQUISITION of data , *URBAN hospitals , *BENCHMARKING (Management) , *TREATMENT effectiveness , *HOSPITAL care , *MEDICAL referrals , *MEDICAL records , *DESCRIPTIVE statistics , *BODY mass index , *DISEASE management , *OUTPATIENT services in hospitals , *LONGITUDINAL method , *ADULTS - 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/m2), 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. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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