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niallvvInto the blue yonder?
Capturing diabetes transition in a regional
metropolitan centre,
Auckland, New Zealand, 2006-2013
Dr Craig Jefferies
Dr Craig Jefferies
Presenter Disclosure
Information
Dr Craig Jefferies
Disclosed no conflict of interest.
Starship Diabetes service:
Where we are
The scene: Starship
NZ has a social security based health care system
No financial barrier to healthcare access
Regional Paediatric diabetes service
Greater Auckland region ~1.5million
Capture >95% all children and young people with
diabetes
Geographically spread (>70K north to south)
Ethnically diverse
Mod-high rate of type 1 diabetes ~25-30/100,000
Starship Childrens Health:
Regional metropolitan service
Feeds into 3 adult catchments
80 K
Starship diabetes service
Total patients
Average age
500
9 yrs
Length of diabetes
3.8
Average HbA1c
8.5 (1.4)%
Ethnicity
Maori 8%
NZ European 69%
Pacific Island 13%
150 pumper
+/- 2.8 years
Background: Adolescent
service
Previous ad-hoc adolescent clinic defunct in 2004-5
Disjointed, after hours and off-site
No continuity of care
Paed patients decanted into this at 14 years
Ended at 19 with no set transfer out
Most transfer out with a DNA
Need for a formal service from 2005 on.
Transfer out occurred from 2006
A Transfer/Handover Model
2 year Sequential Transition Model within a
developmental youth health context
Fixed end point for transfer of care 16-17 yrs
Nurse Transition Coordinator
Centre for Youth Health (SDRR team)
Capture and HbA1c tracking 5 years post transition
or to age 21
On-going liaison with the 3 different Adult Services
The Transition Programme
Entry
14 yrs
Negotiated
Care
Consultation
Transition
Preparation
One
15 yrs
Transition
Preparation
Two
Discharge
16 yrs
17 yrs
Standard 3 monthly Adolescent Clinics
Each case individually managed by Transition Coordinator
Multidisciplinary approach with youth health, psychology, medical team
Adolescent diabetes specific education throughout
Not combined paediatric/adult clinics
NOT after hours
Paediatric clinic space used NOT adolescent specific environment
Objectives
Capture rates
To examine the capture rates of young people transitioned
from the Starship Adolescent Diabetes Service
Metabolic control
To examine HbA1c between those who engaged or not
Other measures
Ethnicity and social deprivation within the transitioning
population
Definitions
Captured
Retained
Attended at least 1 adult clinic
Remains in adult clinics 5 years since referral or to age
21
Opted Out Active decision to not engage in
Transition programme
excludes relocation or recurrent DNA
116
64
102
Other = 40
Results
322 young people transferred through
Sept 2006 to Jan 2013.
96% rate of capture of all the young people into at least
one Young Adult Clinic.
88% of the young people were captured and retained in
clinics from the whole period of transition to age 21.
120
100
98
85
80
92
71
60
TN
NO TN
40
P < 0.001
20
322 in TN
44 No TN
0
CAPTURED
RETAINED
94% T1DM
96% of all young people captured
88% young people captured and retained
Results: Adult capture
Of the 308/322 captured into adult services,
80% were captured within 6 months.
No difference in capture related to dep score (p = 0.9).
No difference in capture related to Ethnicity (p = 0.20).
Results: metabolic
Those engaged in the transition programme were more
likely to have lower HbA1c than those who did not engage
(p=0.007)
The more deprived young people had higher HbA1c scores
(p=0.0001).
The Maori and Pacific Island populations had higher HbA1c
(p=0.0001).
Deprivation and HbA1c
100
High Deprivation
Low/Med
Deprivation
80
HbA1c
60
0
2
Years Since Transfer
Ethnicity and HbA1c
Maori/Pacific
100
Other
Europ
80
HbA1c
60
0
2
Years Since Transfer
HbA1c by Adult service
100
CM YAC
W YAC
NS YAC
80
HbA1c
GCC YAC
60
0
2
Years Since Transfer
Conclusion
The Starship transitional programme/ adult regional
model is helping achieve a high rate of attendance
in transition
Major geographical changes between paediatric and
adult clinics do not affect capture rates across
Auckland
Areas of real need are improving metabolic control
before and during transfer in Non-Europeans and in
those of low socio-economic status
Acknowledgments
Starship Childrens health
Dr Fran Mouat, Dr Phillipa Carter, Dr Natasha Heather, Prof Paul Hofman, Dr
Ben Albert, Sheryl Tregurtha, Grace Harris
Youth Health
Dr Bridget Farrant
Adult services
Jane Bennett, Ann Whitwell, Dr Rick Cutfield, Lisa Stevens, Jo Naylor, Jenne
Pomfret, Kristine Frew, Dr Paul Drury, Diane Bermingham, Caroline Griffin, Dr
Brandon Orr-Walker, Theresa Busler
Into the blue yonder?: Capturing diabetes transition in a
regional metropolitan center, Auckland, New Zealand,
2006-2013
has been accepted for an oral presentation. Please note
that your abstract is registered under the number O46.
Session Title: Oral Session VI: Diabetes and Adolescence
Session Date: September 4, 2014
Session Time: 11:00-12:30
Session Room: Grand Ballroom West
Presentation: 7 minutes + 4 minutes Questions &
Answers
