Introduction: Young adults with T1D have unique care needs due to disease and psychosocial factors.  Crises resulting in unscheduled presentations to ED are common, with NSW studies showing that 45-50% of patients with T1D living outside Sydney present to ED for diabetes-related care one or more times per year^1,2. We aimed to explore factors that are associated with Emergency Department presentations in a cohort of 18-25 year old patients with T1D under care of a regional tertiary diabetes clinic.

Methods: Retrospective chart review of patients attending the John Hunter Hospital Young-Persons Diabetes Clinic (YPC) over a 24-month period (2013-2014), correlated with ED presentation data.

Results: 212 patients were identified, with mean age of 22 years and mean duration of diabetes of 10.8 years.  Patients had been attending YPC for a mean 1.8 years, and attended a mean of 2.6 clinic visits/year.  Mean HbA1c was 8.5%.  71% of patients administered insulin using multiple daily injections, and 28% via subcutaneous pump.

67 patients had one or more diabetes-related ED encounters during 2013-2014 (32% of the clinic cohort in 2013, 28% in 2014).  39 patients had one encounter, and 28 had 2 or more encounters (range 2-21), generating 163 diabetes-related ED encounters.  117/163 encounters resulted in admission (71%). 

Patients presenting to ED were more likely to be younger (21.2 vs 21.9 years, p=0.02), have shorter duration of diabetes (8.5 vs 11.6 years, p<0.001), have a higher HbA1c (9.2% vs 8.2% p=0.005), and have a shorter duration of YPC contact (1.5 vs 2.0 years p=0.02) compared to ED non-presenters.  ED presenters were also more likely to have a documented mental health disorder (34% vs 15% p<0.001).  

Discussion: This study confirms that young adulthood is a period of instability for patients with T1D, resulting in high unplanned service utilisation and high admission rates.   The rate of ED-presentation in this study (patients of a tertiary clinic) was lower than previous studies examining all patients with T1D in the same region (28-32% vs 45-50%).  Further clinic interventions, particularly targeting mental health in this high risk group, may improve care delivery and clinical outcomes.