Tackling the burden of youth onset Type 2 diabetes: a pilot collaborative study in tertiary and primary care settings — ASN Events
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Tackling the burden of youth onset Type 2 diabetes: a pilot collaborative study in tertiary and primary care settings (#13)

Margaret McGill 1 2 , Amanda Jones 3 , Svetlana Serafimov 3 , Lynda Molyneaux 1 2 , Maria Constantino 1 2 , Michael Moore 3 , Ted Wu 1 , Jencia Wong 1 2
  1. Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  2. Discipline of Medicine, University of Sydney, Sydney, NSW, Australia
  3. Inner West Sydney Medicare Local , Ashfield, NSW, Australia

Awareness of the problem of Type 2 diabetes in young people (YT2DM) is increasing. We and others have reported on their poor prognosis, higher risk of complications and mortality. Much of this evidence is derived from tertiary care institutions (TC) and it is unknown if these observations are representative of YT2DM in community primary care (PC).  We report on a pilot collaborative study between the RPA Diabetes Centre (a TC) and Inner West Sydney Medical Local (IWSML representing PC) to examine the clinical characteristics of two YT2DM cohorts, i)aged≤ 30 (YT2DM≤ 30) and ii)aged ≤40 (YT2DM≤ 40) .De-identified data from 133,682 patients  extracted from the electronic health records of GP practices participating in a IWSML Putting Data into Practice  Program over 2 years were available for study. Data was also extracted from the RPAH Diabetes Centre Clinical database over a similar period for comparison, all with HREC approval. Data on 94 YT2DM≤ 30 and 526 YT2DM≤ 40 are shown in Fig. In YT2DM≤ 30 : the majority are female; similar rates of obesity in youth are seen with >50% subjects obese , half of whom are morbidly obese (BMI>40kg/m2); glycaemic control was poor in both settings with an HbA1C > 8% seen in >30% of patients;  despite their young age, >30% had a BP >target 130/80mmHg, a third of whom with a BP>140/90mmHg; similarly, abnormal albuminuria is present in over 30% of subjects but a lesser proportion were using  RAAS blockade in either setting; over 50% had an LDL >2.5mmol/L but the prevalence of statin use was much lower; triglycerides were elevated in more than 40% of patients and  HDL <1mmol/L in ~25%; over 20% of patients are current smokers.YT2DM≤ 40 demonstrate similar profiles (across both patient care settings). These results suggest that the TC picture of YT2DM, largely reflects that seen in the community setting.  For YT2DM, unfavourable cardiometabolic risk profiles are evident, and it appears that significant treatment gaps persist for YT2DM, in any setting.  Further collaborative platforms coupled with innovative- integrated models of care should be explored to understand barriers and improve outcomes for this high risk.

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