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ONLY about one in seven (14%) young Australians with type 1 diabetes may be receiving the level of multidisciplinary care specified in national guidelines, raising concerns that diabetic services are underresourced.
The new Australian research, published in Diabetes Research and Clinical Practice, also found that only one in 10 young people are meeting the recommended targets for glycaemic control. (1)
The longitudinal study examined the use of health services by 158 young people with type 1 diabetes — all aged 8‒19 years, living in the ACT or NSW and recruited between August 2006 and December 2007 — over a 3-year period. It is the first study to compare the standard of care in the community with clinical guidelines. Australian clinical practice guidelines for children and adolescents with type 1 diabetes were published in 2005. (2)
Researchers interviewed each young person and their family each year about self-care and use of health services, and took a blood sample to measure glycated haemoglobin (HbA1c) levels.
In the first year of the study, only 13% of the young people had an HbA1c level below 7.5%, which is recommended by national guidelines. In the third year of the study, less than 10% of the study population had reached this target.
“[This is] an alarming finding given the long-term issues associated with poor glycaemic control throughout adolescence”, the researchers wrote.
Visits to health professionals also fell well short of the guidelines and generally declined over the 3-year study period. Only 24.7% of the young people received care from all recommended members of the multidisciplinary team during the first year of the study, dropping to just 13.8% by the third year.
The young people who did see all team members were more likely to have a higher HbA1c than those who missed out on this multidisciplinary care. The researchers suggested that this could “reflect the use of glycaemic levels to prioritise limited appointments”.
The researchers said that existing diabetic services may not be sufficiently resourced to cope with demand.
“The increased number of young people being diagnosed with type 1 diabetes may be placing pressure on existing resources with preference being given to those young people who are recently diagnosed and/or more novice in terms of diabetes care”, they wrote.
Study participants also reported difficulties in making routine 3-monthly appointments with multidisciplinary team members due to insufficient staff.
Although most of the young people did not receive the recommended care, they saw an average of 4-5 different health professionals each year. In the third year, 88.3% saw an endocrinologist; however, only 58.6% saw a GP and only 42.8% attended a dietitian.
The researchers suggested that some young people and their families may have decided not to attend appointments if they felt they were sufficiently managing their diabetes, or if they had been dissatisfied with the care received.
The study also found that the proportion of people using insulin pumps increased from 27.8% in the first year, to 49.6% in the final year of the study. However, the researchers said this increase did not result in improved glycaemic control for the group as a whole or for those using pump therapy during the study period.
– Sophie McNamara
1. Diabetes Research and Clinical Practice 30 May 2011 (Online)
2. NHMRC: Clinical practice guidelines: Type 1 diabetes in children and adolescents 2005
Posted 14 June 2011