Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

Comparison of service utilisation and outcomes in young adults aged 16-25 managed with multiple daily injections(MDI) and continuous subcutaneous insulin infusion (CSII) (#161)

Jane Holmes-Walker 1 , Glen YJ Chew 2 , Kaye Farrell 3
  1. Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia
  2. Sydney Medical School, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
  3. Diabetes Transition Support Program, Westmead Hospital, Westmead, NSW, Australia

Background: The young adult diabetes transition program began in 2002 to support young people with diabetes as they moved from paediatric to adult services. An increasing proportion of youth with type I diabetes (YWD) are managed with insulin pump therapy.

AIM: To compare outcomes of diabetes control and service utilisation in MDI users as compared with CSII in YWD attending a youth specific diabetes service

METHODS: Data was collected on all patients attending between Jan 2013 and Dec 2014 including treatment modality, duration of diabetes, years since first referred to young adult service, frequency of visits, HbA1c (mean of all visits), phone calls to support service for sick day management, and DKA admissions over study period

RESULTS: There were 291 attendees of which 57% were on MDI, 36% were on CSII and 7% changed to CSII during the study period. Average duration of clinic attendance at start of the study period was 3.9 years with average duration of diabetes of 10.1 years. Median interval between appointments was 4 mths in CSII and 4.8 mths in MDI (p =0.018). Mean HbA1c in CSII users was 8.85% and in MDI users 9.35% (p<0.05). There were 28 admissions with DKA over the study period in 17 individuals; 5 in CSII (n=5, 4%) and 23 in MDI (n=12,7%) users. Admissions as proportion of number of CSII and MDI users were not significant but significantly higher in MDI users after accounting for multiple admissions (p<0.01). The proportion using after hours phone support for hyperglycemic events was greater in CSII (15.3% ) than MDI users (7.3%, p=0.03).

Conclusion: YWD managed with CSII had lower HbA1c, higher frequency of attendance and lower DKA admission rates than MDI users. CSII users were more likely to use after hours phone support for hyperglycemic events potentially reducing DKA admissions in CSII users.