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

Abstract

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.

Young people with type 1 diabetes mellitus: Attitudes, perceptions, and experiences of diabetes management and continuous subcutaneous insulin infusion therapy

“…Findings were consistent with previous studies of young adults with T1DM in this region of New South Wales and elsewhere and are cause for concern, especially considering the accompanying positive attitudes, high perceived self‐efficacy, and diabetes self‐management abilities also reported. High rates of hypoglycemia and acute service use for diabetes‐related problems were also consistent with findings from young adults with T1DM . CSII use did not appear to confer a significant advantage in glycemic control, although this study lacked statistical power to demonstrate this.…”

“…Overall, the patterns of glycemic control reported by these participants could not be described as optimal. [32][33][34] Findings were consistent with previous studies of young adults with T1DM in this region of New South Wales 35,36 and elsewhere [37][38][39] and are cause for concern, especially considering the accompanying positive attitudes, high perceived self-efficacy, and diabetes self-management abilities also reported. High rates of hypoglycemia and acute service use for diabetes-related problems were also consistent with findings from young adults with T1DM.…”

“…High rates of hypoglycemia and acute service use for diabetes-related problems were also consistent with findings from young adults with T1DM. 35,13,36 CSII use did not appear to confer a significant advantage in glycemic control, although this study lacked statistical power to demonstrate this. However, findings highlight the importance of good preparation and support for CSII use.…”

“…Given the cost to provide CSII and the human resources required to support CSII users, discontinuance and any failure to improve real‐life clinical outcomes are disappointing . One reason for suboptimal outcomes might be that stretched diabetes teams, especially in rural areas, lack adequate specialist resources to provide the more complex and time‐consuming support needed to optimize results . Where this is the case, service redesign is required to improve support particularly but not exclusively for CSII users.…”

The Lymph Nodes in Rats With Experimental Type 1 Diabetes Mellitus (Dm-1)

“…The structures protecting the mucous membrane are called mucosa associated lymphoid tissue -MALT. MALT consists of visceral lymph nodes of gastrointestinal tract, being the place to induce humoral (antibody mediated) and cellular immunity [6]. The analogue of such tissue in the conducting airway is the nasal-associated lymphoid tissue (NALT) or lymphoid tissue associated with the nasal cavity, which is the regional representative of submucosal of the immune system.…”