High risk young adult population - need for a multidisciplinary team approach

Abstract

Background: Diabetes management is complex but diabetes within the adolescent population with complex social issues can lead to increase in hospital admission rate and requires extra support to assist with the improvement of diabetes management. Aim: To identify the young adult population with multiple missed clinic appointments (>2 appointments) and review their glycaemic control, hospital admission rates and total hospital stay days. Methods: Out of the young adults on the register, those who missed more than 2 clinic appointments from 2015-2016 is identified as ‘high-DNA’. Out of this list, glycaemic control (mean from last three HbA1c), hospital admission (past 5 yrs) and total hospital stay days were analysed. Results: Thirty five young adults met the DNA criteria with a total of 252 missed appointments in the past two-years, 167 hospital admissions[4.8(5.3)] and 460 hospital days[13.1(22.2)] in the past 5 years. An average hospital stay costs $1051, which equates to $484k. Pacific (46%) and Maori (20%) were over-represented with 23% European and 11% Asian and there were marginally more people with Type 1 (T1D) than Type 2 (T2D), 54% and 46%, respectively. Poor glycaemic control with HbA1c 98(27.3)mmol/mol, with a higher HbA1c in the T1D population when compared to the T2D, 100(6.2) and 96(7.1),respectively. Additional data will be presented in May 2017. Conclusion: There is a need to focus on this diabetes DNA population with individualised plan to work with these patients on why they are not coming to their clinic appointment. Cultural differences would need to be prioritised and considered as the Pacific and Maori ethnicities make up a majority of this high DNA population. Due to the complexities with managing young people with Diabetes, there is a need for a multidisciplinary team approach with the specialist, nurse, dietitian, psychologist, social worker, paediatric team, management and other relevant bodies involved.