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BACKGROUND Limited studies have compared outcomes between emerging adults with type 1 diabetes mellitus (T1D) attending a diabetes transition support programme using multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). AIMS To assess glycaemic control and service utilisation in emerging adults with T1D on MDI or CSII attending a young adult diabetes clinic (YAC). METHODS A retrospective cohort analysis was conducted from January 2013 to December 2015. Data collected included clinic visits per-year, after-hours mobile phone use, diabetic ketoacidosis (DKA) admissions and all HbA1c levels. Independent t-test was used to compare continuous variables whilst Pearson's chi-squared test was used for categorical variables. Linear mixed effects models explored mean changes in HbA1c levels over time. RESULTS Over 3 years, 318 youth with T1D (176 MDI, 121 CSII, 21 switched from MDI to CSII) attended our YAC. Aggregated mean HbA1c levels remained similar between modalities (CSII 9.1% vs. MDI 9.3%, p = 0.23), however, mean change in HbA1c at 3 years was significantly increased in CSII users at 0.55% (95% CI 0.15% to 0.95%, p

People with type 1 diabetes (T1D) aged21 years are eligible for subsidised continuous glucose monitoring (CGM) products under the Australian National Diabetes Services Scheme. There are few real-world published studies to evaluate the benefits of CGM in young adults.To perform a real-world observation study among youth with T1D to evaluate CGM use and benefits of CGM.Patients at the Westmead Hospital Young Adult Diabetes Clinic aged 15-21 years who commenced CGM before July 2018 were followed for 6 months post commencement of CGM. Differences in HbA1c and glucose metrics at baseline and follow up are compared between those commencing CGM and those that did not.Forty-four (38%) of 115 eligible patients commenced CGM. Demographic characteristics and baseline HbA1c did not differ significantly between those started on CGM and those that did not. At 6 months, 18 (41%) of 44 patients still used CGM, with discomfort and inconvenience the most common reasons for dropout. In CGM continuers, at 6 months compared with baseline, there was no change in HbA1c (8.2% vs 8.0%; P = 0.8), coefficient of variation of glucose (38% vs 39%; P = 0.5) or percentage time in range (52% vs 58%; P = 0.3). Six-month follow-up HbA1c in CGM non-users deteriorated significantly compared with users. Mean hypoglycaemia fear scores (worry scale) were significantly decreased from baseline at 6 months (33 vs 18; P 0.01).There are high rates of discontinuation in CGM use among youth with T1D. At 6 months of CGM use, there was no significant change in glycaemic control, although HbA1c in non-users deteriorated significantly. Worry of hypoglycaemia was significantly decreased among those who continued CGM.

AIMS: To assess differences in knowledge and beliefs about pregnancy in women with diabetes. METHODS: Questions were from the Australian 'Contraception, Pregnancy & Women's Health' survey. Women (18-50 years) were eligible if pregnant or planning pregnancy. Knowledge and beliefs items were adapted from the Reproductive Health and Behaviours Questionnaire. RESULTS: Compared to women with type 2 diabetes (n = 103), women with type 1 diabetes (n = 526) had higher scores for knowledge about pregnancy in diabetes (type 1 diabetes 9.8 ± 2.4 vs. type 2 diabetes 7.7 ± 3.1), beliefs about benefits (type 1 diabetes 18.4 ± 2.2 vs. type 2 diabetes 17.2 ± 3.3), cues-to-action (type 1 diabetes 2.7 ± 1.4 vs. type 2 diabetes 1.5 ± 1.3) and self-efficacy (type 1 diabetes 22.6 ± 5.5 vs. type 2 diabetes 20.2 ± 6.1 (all p

Background Management of Type 1 diabetes mellitus (T1DM) in youth with diabetes is complex and glycaemic control often deteriorates during this challenging period. We hypothesise that attendance at a youth-specific diabetes clinic reduces hospital admission rates and length of stay for diabetic ketoacidosis (DKA). Aims This study aimed to assess the impact of a youth specific diabetes service for youth with diabetes (YWD) on DKA admissions in two adjacent local health districts (LHDs). Methods A retrospective cohort analysis of admissions for DKA in YWD aged 15-25, presenting to four hospitals in Western Sydney in 2011 was performed. Number of admissions, length of stay (LOS) and DKA severity were assessed. Cost was analysed as a function of LOS. Groups were divided by attendance at a youth-specific diabetes service or no record of attendance. Results There were 55 DKA admissions from 39 patients (median age 20.0 years); the majority of admissions (82%) were YWD not supported by a youth-specific diabetes service. Median LOS was significantly longer in the unsupported group (3.0 days vs. 1.5 days, p=0.028). Median pH at presentation in the unsupported group was significantly lower, 7.11 versus 7.23 (p=0.05). There was a 4-fold greater admission rate in those not supported by youth-specific diabetes services, 5.5% compared with 1.6% (p=0.001). The estimated cost saved by youth-specific services was over $250,000pa. Conclusions Lack of access to supported care for YWD at the transition has an adverse impact on DKA admission rates and LOS.

Aims and Objectives: The aim of this paper was to evaluate the impact of phone support on sick day management of young people with type 1 diabetes.Method: Qualitative exploratory study to understan...

In 2001 a model of care for transition of youth with diabetes (YWD) was implemented at Westmead Hospital and published in 2007. In 2017, Australian National Diabetes audit (ANDA) conducted a month survey of all people with diabetes attending participating centers. The Australian Diabetes Data Network (ADDN) is a newly established national database. Aim: To determine if benefits are conferred by a youth specific transition care model as compared with other Australian adult health care settings for YWD age 16-25. Methods: An audit of all T1D Westmead clinic attendees aged 16-25 in 2017 including age, duration diabetes, HbA1c, urine microalbumin/creatinine ratio in the last 12 months, BP, most recent retinal review and results compared with the ANDA outcomes for youth attending adult health care settings for management of diabetes. Subjects within 1 year diagnosis and pregnancy excluded. Results: Key: HbA1c median (25th-75th centile), [n] missing * p Conclusion: Similar levels of diabetes control were achieved regardless of center indicating importance of follow-up in this age group although control was suboptimal. Complications screening was more effective with a dedicated transition. Disclosure J. Holmes-Walker: None. P. Rueter: None. K. Farrell: None.

Background: People with T1DM under 21 are eligible for subsidised continuous glucose monitoring (CGM) products under the Australian National Diabetes Services Scheme. There are few “real world” published studies to evaluate the benefits of CGM in young adults. Aim: To determine whether CGM is associated with improvement in glycaemic markers amongst eligible T1DM patients. Methods: Patients at the Westmead Hospital young adult diabetes clinic aged 16-21 who commenced CGM prior to July 2018 were followed-up for 6 months after CGM commencement. Differences in HbA1c and glucose metrics at baseline and follow-up are compared between those started on CGM and those who were not. Results: There were 115 eligible patients, of which 38% (n=44) commenced CGM. There were no differences in age, gender or baseline HbA1c of those started on CGM vs. those who were not. CGM users were more likely to use CSII than MDI (n=27 vs. 17, P=0.02), and came from post code areas which had higher median household incomes, despite fully subsidised CGM costs. At 6 months follow-up, only 41% (n=18/44) were confirmed to still be using CGM, with common reasons for dropout being discomfort, inconvenience, and disruptive alarms. Of those who continued, there was no change from baseline to 6 months in HbA1c (8.2±1.3% vs. 8.3±1.5%, P=0.7), coefficient of variation of glucose (0.39 vs. 0.38, P=0.5), or % time in range (54% vs. 58%, P=0.3), with average CGM wear time 65% in the 4 weeks prior to follow-up visit. At 6 months there was a weak correlation between percentage use of CGM and HbA1c reduction (R=0.46, P=0.07). Mean hypoglycaemia fear scores (worry scale) was significantly decreased from baseline at 6 months (33 vs. 18, P Conclusion: There are high rates of discontinuation in CGM use amongst T1DM patients aged 16-21. At six months of use there was no significant improvement in glycaemic control, although higher CGM usage was weakly correlated with increased time in range. Worry of hypoglycaemia was significantly decreased amongst those who continued CGM. Disclosure M. Lee: None. J. Holmes-Walker: None. K. Farrell: None.

Aims To describe factors associated with the uptake of diabetes-specific pre-pregnancy care (PPC), determine the perceived helpfulness of attending, reasons for non-attendance and intention to seek PPC in the future. Methods A cross-sectional 66-item survey was administered to Australian women with type 1 or type 2 diabetes mellitus (DM) aged 18–50 years. Results Of 429 eligible women, 54% reported having attended PPC. In multivariable logistic regression analysis, having Type 1 DM [adjusted OR 1.89, 95% CI (1.07, 3.33)], being married or in a defacto relationship [OR 2.43 (95% CI 1.27, 4.65)], tertiary educated [OR 1.91 (95% CI 1.27, 2.88)] or employed [OR 1.80 (95% CI 1.14, 2.82)] were associated with being more likely to attend PPC. Sixty eight percent (68%) rated attending PPC as helpful. A lack of awareness about the availability of PPC (48%) and unplanned pregnancy (47%) were the main reasons for non-attendance. Of women with future pregnancy plans, 43% were aware of local services offering PPC and 84% indicated they would attend PPC if available. Conclusion Australian women who attend PPC differ by type of diabetes and socioeconomic characteristics. Initiatives are needed to address this disparity and encourage all women with diabetes to plan and prepare for pregnancy. Reasons reported for non-attendance suggest that strategies to increase awareness about the availability of diabetes-specific PPC and the risks of unplanned pregnancy are warranted.

Management of type 1 diabetes mellitus in youth with diabetes (YWD) is complex, and glycaemic control often deteriorates during this challenging period. We hypothesise that attendance at a youth-specific diabetes clinic reduces hospital admission rates and length of stay (LOS) for diabetic ketoacidosis (DKA).To assess the impact of a youth-specific diabetes service for YWD on DKA admissions in two adjacent local health districts.A retrospective cohort analysis of admissions for DKA in YWD aged 15-25 years, presenting to four hospitals in Western Sydney in 2011 was performed. Number of admissions, LOS and DKA severity were assessed. Cost was analysed as a function of LOS. Groups were divided by attendance at a youth-specific diabetes service and no record of attendance.There were 55 DKA admissions from 39 patients (median age 20.0 years); the majority of admissions (82%) was YWD not supported by a youth-specific diabetes service. Median LOS was significantly longer in the unsupported group (3.0 vs 1.5 days, P = 0.028). Median pH at presentation in the unsupported group was significantly lower, 7.11 versus 7.23 (P = 0.05). The admission rate was four times greater for those not supported by youth-specific diabetes services, 5.5% compared with 1.6% (P = 0.001). The estimated cost saved by youth-specific services was over $250,000 pa.Lack of access to supported care for YWD during transition from paediatric to adult care has an adverse impact on subsequent DKA admission rates and LOS.

Research Question: What factors determine diabetes care outcomes for young adults with type 1 diabetes after transition from paediatric to adult health care services? Criteria for considering studies for this review: Types of participants: People aged 15-19 years inclusive with diagnosis of type 1 diabetes who have been transitioned from paediatric to adult health care services. Types of outcome measures: The primary outcomes are: Diabetes control as measured by HbA1c at follow-up Loss to follow-up Adherence to insulin therapy Incidence of hospital admission for acute complications Frequency and regularity of clinic attendance Secondary outcomes: Uptake of screening for long term diabetes complications Cost effectiveness of intervention Health related quality of life Patient satisfaction

Following the introduction of highly active antiretroviral therapy, an expanding cohort of adolescents with perinatally acquired HIV (PaHIV) is surviving and emerging from pediatric services with complex transition health care requirements. Transfer from pediatric to adult services has been associated with poorer health outcomes in other chronic diseases. Young people with HIV have the additional burden of stigma, secrecy, and the risk of transmitting HIV to partners and offspring. Maintaining engagement in health care during adolescence is critical. We compare reported satisfaction surveys of health care experiences and preferences of young people with PaHIV attending a U.K. transition outpatient service with young people attending a young persons' diabetes transition service in Australia. All 21 patients in the United Kingdom and 39 young people approached in Australia agreed to participate. The median age for both groups was 19 years, 67% of the PaHIV group were black African and 74% of diabetic group white Australian. Ninety-five percent (18/19) of those with PaHIV and 87% (34/39) with diabetes felt their transition was an easy process. Sixty-eight percent (13/19) of young people with PaHIV and 72% (28/39) of diabetic patients felt moving to their current service had a positive effect on their health. Being treated as an individual, comprehensive management explanations and encouragement to develop independence were cited as "strongly important" by over three quarters of participants with PaHIV. This service evaluation illustrates that careful transition can be a positive event for young people with PaHIV, comparable to that of a well-established diabetes services.

Diabet. Med. 28, 1001–1004 (2011) Abstract Aims To determine if access to mobile phone support for sick-day management is associated with reduced hospital admissions with diabetic ketoacidosis in young adults aged 15–25 with Type 1 diabetes. Methods This was an observational study with data collected prospectively from January 2005 to December 2008. A mobile phone support service for sick-day management began in May 2005. Data from clinic attendees (group 1), including age, sex, diabetes duration, referral age, insulin therapy delivery, clinic attendance and HbA1c, were compared with clinic attendees with diabetic ketosis accessing sick-day management phone support (group 2), clinic attendees not accessing phone support and admitted with diabetic ketoacidosis (group 3) and non-clinic attendees admitted with diabetic ketoacidosis (group 4). Results Age was similar in all groups. Patients in group 3 had significantly shorter duration of diabetes (6.8 ± 3.1 years) than groups 1 or 2 (10.1 and 9.8 years, respectively). Diabetes control was poor in all presentations of diabetic ketoacidosis (groups 2–4, HbA1c > 97 mmol/mol, > 11%) and was significantly higher than clinic attendees without ketosis (HbA1c 70 mmol/mol, 8.6%; P

To determine if a transition support programme for young adults with diabetes could maintain attendance at a specialist clinic, improve diabetes control and reduce acute hospital admissions with diabetic ketoacidosis (DKA) in 15-25-year-olds with Type 1 diabetes.A transition coordinator/diabetes educator arranged booking and rebooking of appointments for a young adult diabetes clinic based in an adult hospital between July 2001 and March 2006. An after-hours phone support service was initiated. Data collected included source of referral, frequency of clinic attendance and HbA1c at each visit. Numbers of admissions and readmissions with DKA, length of stay and HbA1c on admission were recorded.One hundred and ninety-one young adults were referred. HbA1c at initial referral was 9.3 +/- 2.17%. HbA1c significantly improved to 8.8 +/- 1.9% (P0.001) after a median of five visits with a statistically significant fall in HbA1c of 0.13% per visit (P = 0.01). The greatest improvements were seen in those with starting HbA1c11% (-2.5 +/- 2.3%, P0.001). Eighty-two percent had attended appointments in the last 6 months. There was a significant reduction in DKA admissions falling by 1/3 (P = 0.05), and in readmissions a significant reduction in length of stay (-3.6 days, P = 0.02), over 3.5 years.If young adults are appropriately supported in adult services, clinic attendance is maintained, diabetes control is improved and hospital admission rates with DKA are reduced. The cost savings from reduced admissions covered the costs of the programme.