Application of Australian clinical management guidelines: The current state of play in a sample of young people living with Type 1 diabetes in the state of New South Wales and the Australian Capital Territory

Hatherly, Kristy; Smith, Lorraine; Overland, Jane; Johnston, Christine; Brown-Singh, Lin

doi:10.1016/j.diabres.2011.04.017

Cited by 11 publications

(12 citation statements)

References 8 publications

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“…This transition stage was first formally identified as challenging by Blum et al [11], however, decades later similar levels of difficulty with the transition process are still being reported [12]. Consequently, young adults with type 1 diabetes may not adhere to diabetes regimes, and may disengage from diabetes services after transition [13, 14]. Attrition from, or failure to engage with, diabetes services as an adult too-frequently results in reduced diabetes self-management and well-being, and inadequate screening for complications.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of vascular complications and factors predictive of their development in young adults with type 1 diabetes: systematic literature review

et al. 2014

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BackgroundVascular complications curtail life expectancy and quality of life in type 1 diabetes and development at younger ages is particularly detrimental. To date no review has summarised the prevalence or factors predicting their development in young adults.MethodsA quantitative epidemiological systematic review was conducted to identify the prevalence and predictive factors for development of retinopathy, nephropathy and hypertension in young adults (sample age mean [plus 1SD] 18–30 years) with type 1 diabetes, using processes adapted from established review methods set out by the Centre for Reviews and Dissemination.MEDLINE (Ovid), Scopus (Elsevier), CINAHL, Science Direct (Elsevier), Google Scholar and Cochrane databases were searched to identify relevant articles published between 1993 and June 2014. From this eleven papers were retrieved, appraised and results summarised by three reviewers using established methods.ResultsSome form of retinopathy occurred in up to almost half of participants; more severe forms affected up to one in ten. One in six was reported with microalbuminuria; one in 14 had macroalbuminuria. Hypertension occurred in almost one in two participants. Applying out-dated high thresholds this decreased to approximately one in ten participants. Glycaemic control was a consistent predictor of vascular disease in this age group.ConclusionPrevalence rates of retinopathy, nephropathy and hypertension in young adults with type 1 diabetes emphasise the importance of regular complication screening for early detection and treatment. The predictive effect of glycaemic control reinforces its importance for prevention of vascular complications.Electronic supplementary materialThe online version of this article (doi:10.1186/1756-0500-7-593) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Prevalence of vascular complications and factors predictive of their development in young adults with type 1 diabetes: systematic literature review

et al. 2014

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“…Early adulthood years are particularly important as this is when patterns of independent self-management are established. Young adults with type 1 diabetes may be particularly vulnerable to the development of complications as they may not receive disease-specific or age-appropriate care, and may disengage from the support of diabetes services when they leave the paediatric services they grew up with, at an age when adherence to diabetes self-management regimens is often reported as suboptimal [1,3-5]. Case note audit of young adults with type 1 diabetes accessing diabetes services in the state capital, a city and regional areas of New South Wales (NSW) in Australia demonstrated inadequate routine specialist care, poor self-management and frequent use of acute services for crisis management, particularly in regional areas [4]; however, sample sizes were small.…”

Section: Introductionmentioning

confidence: 99%

Service usage and vascular complications in young adults with type 1 diabetes

et al. 2014

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BackgroundFew studies have examined young adults with type 1 diabetes use of health services and the development of vascular complications. As part of the Youth Outreach for Diabetes (YOuR-Diabetes) project, this study identified health service usage, the prevalence and factors predictive of development of vascular complications (hypertension, retinopathy and nephropathy) in a cohort of young adults (aged 16–30 years) with type 1 diabetes in Hunter New England and the Lower Mid-North Coast area of New South Wales, Australia.MethodsA cross-sectional retrospective documentation survey was undertaken of case notes of young adults with type 1 diabetes accessing Hunter New England Local Health District public health services in 2010 and 2011, identified through ambulatory care clinic records, hospital attendances and other clinical records. Details of service usage, complications screening and evidence of vascular complications were extracted. Independent predictors were modelled using linear and logistic regression analyses.ResultsA cohort of 707 patients were reviewed; mean (SD) age was 23.0 (3.7) years, with mean diabetes duration of 10.2 (5.8, range 0.2 - 28.3) years; 42.4% lived/ 23.1% accessed services in non-metropolitan areas.Routine preventative service usage was low and unplanned contacts high; both deteriorated with increasing age. Low levels of complications screening were found. Where documented, hypertension, particularly, was common, affecting 48.4% across the study period. Diabetes duration was a strong predictor of vascular complications along with glycaemic control; hypertension was linked with renal dysfunction.ConclusionFindings indicate a need to better understand young people’s drivers and achievements when accessing services, and how services can be reconfigured or delivered differently to better meet their needs and achieve better outcomes. Regular screening is required using current best practice guidelines as this affords the greatest chance for early complication detection, treatment initiation and secondary prevention.

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“…Eligibility criteria included children from 10 to 17 years of age, diagnosed with T2D within the last 2 years, with negative pancreatic auto-antibodies, sustained c-peptide and a BMI greater than the 85 th percentile for age and sex 61 . Of the 1,206 obese subjects screened and considered clinically to have T2D, 118 (9.8%) were positive for GAD-65 and/or insulinoma-associated protein 2 (IA-2) autoantibodies antibodies; of these, 71 (5.9%) were positive for a single antibody, and 47 were positive (3.9%) for both antibodies 61,62 . Thus, without islet autoantibody analysis, it is difficult to reliably distinguish between T1D and T2D in obese youth.…”

Section: Maahs Et Al Cvd Risk Factors In Youth With Diabetes Mellitusmentioning

confidence: 99%

“…62 A study in the United Kingdom found 83.5% compliance with lipid screening with T1DM, 63 and another in children with T2DM found that only half of the patients had lipid testing. 64 In a survey by Gosden et al, 65 only 66% of patients had their BP checked yearly, and other CVD risk factors were not addressed.…”

Section: Overview Of Current Guidelinesmentioning

confidence: 99%