ENHIDE telehealth support for 148 disengaged young adults with type 1 diabetes: a pilot study – rationale and study design
Keywords:young adults, type 1 diabetes, telehealth, disengaged
Disengaged young adults with type 1 diabetes are vulnerable to poor health outcomes. Potentially 20% of those aged 16–30 years could be included in this category. East and North Herts Clinical Commissioning Group (CCG) commissioned the East and North Herts Institute of Diabetes and Endocrinology (ENHIDE) to pilot an innovative model of care in August 2016. Young adults aged 16–30 were offered an alternative model of tailored care, with access to a young adult support worker and specialist nurse. Inclusion in the project was based on fulfilling at least one of the following criteria:
- Acute admission with diabetic ketoacidosis or hypoglycaemia
- Non-attendance for retinal screening
- Non-attendance at clinics on at least two consecutive occasions
- Persistent HbA1c levels >75 mmol/mol
- Non-attendance for routine laboratory measures of glycaemia and renal function
- Multidisciplinary team review stating need for more flexible care
We invited 148 young adults to participate in the project. Of these, 118 have been recruited after the initial contact, markedly exceeding the 10% take-up rate set by the CCG. The project will evaluate changes in emergency admissions, attendance for routine biochemical tests and retinal screening, changes in glycaemic control and quality of life measures at 6 and 12 months after entry to the project
Winocour PH. Care of adolescents and young adults with diabetes – much more than transitional care. A personal view. Clin Med 2014;14: 274–8. https://doi.org/10.7861/clinmedicine.14-3-274
Allen D, Cohen D, Hood K, et al. Continuity of care in the transition from child to adult diabetes services: a realistic evaluation study. J Health Serv Res Policy 2012;17:140–8. https://doi.org/10.1258/jhsrp.2011.011044.
Garvey KC, Wolpert HA, Finkelstein JA. Heath care transition in young adults with type 1 diabetes. Barriers to timely establishment of adult diabetes care. Endocrine Pract 2013;189:946–52. https://doi.org/10.4158/EP13109.OR
Wagner DV, Stoeckel M, Tudor ME, Harris MA. Treating the most vulnerable and costly in diabetes. Curr Diab Rep 2015;15:606. https://doi.org/10.1007/s11892-015-0606-5
Hynes L, Byrne M, Dinneen SF, McGuire BE, O’Donnell M, McSharry J. Barriers and facilitators associated with attendance at hospital diabetes clinics among young adults (15–30 years) with type 1 diabetes mellitus: a systematic review. Pediatr Diabetes 2016;17:509–18. https://doi.org/10.1111/pedi.12198
Smeaton E. Bridging the gap: meeting the healthcare needs of young people with type 1 diabetes. Report for Diabetes UK, 2015.
Castensoe-Seidenfaden P, Jensen AK, Smedegaard H, et al. Clinical, behavioural and social indicators for poor glycaemic control around transfer to adult care: a longitudinal study of 126 young people with diabetes. Diabet Med 2017;34:667–75. https://doi.org/10.1111/dme.13318
Holmes Walker DJ, Llewellyn AC, Farrell K. A transition care programme which improves diabetes control and reduces hospital admission rates in young adults with type 1 diabetes aged 15–25 years. Diabet Med 2007;24:764–9. https://doi.org/10.1111/j.1464-5491.2007.02152.x
Vijayaraghavan S, O’Shea T, Campbell-Richards D, et al. DAWN: Diabetes appointments via webcam in Newham. Br J Diabetes Vasc Dis 2015; 15:123–6. http://dx.doi.org/10.15277/bjdvd.2015.032
Greenhalgh T, Vijayaraghavan S, Wherton J, et al. Virtual online consultations: advantages and limitations (VOCAL) study. BMJ Open 2016;6(1):e009388. https://doi.org/10.1136/bmjopen-2015-009388
Malasanos TH, Burlingame JB, Youngblade L, et al. Improved access to subspecialist diabetes care by telemedicine: cost savings and care measures in the first two years of the FITE diabetes project. J Telemed Telecare 2005;11(Suppl 1):74–6. https://doi.org/10.1258/1357633054461624
Harris MA, Freeman KA, Duke DC. Seeing is believing: using Skype to improve diabetes outcomes in youth. Diabetes Care 2015;38:1427–34. https://doi.org/10.2337/dc14-2469
Franklin VL, Waller A, Pagliari C, Greene SA. A randomized controlled trial of Sweet Talk, a text-messaging system to support young people with diabetes. Diabet Med 2006;23:1332–8. https://doi.org/10.1111/j.1464-5491.2006.01989.x
Johnson B, Elliott J, Scott A, et al. Medical and psychological outcomes for young adults with type 1 diabetes: no improvement despite recent advances in diabetes care. Diabet Med 2014;31:227–31. https://doi.org/10.1111/dme.12305
Carlsen S, Skrivarhaug T, Thue G, et al. Glycemic control and complications in patients with type 1 diabetes: a registry-based longitudinal study of adolescents and young adults. Pediatr Diabetes 2016;18:188–95. https://doi.org/10.1111/pedi.12372
Sildorf SM, Hertel NT, Thomsen J, et al, on behalf of the Danish Study Group of Diabetes in Children. Treatment intensification with improved HbA1c levels in children and adolescents with type 1 diabetes mellitus. Diabet Med 2016;33:515–22. https://doi.org/10.1111/dme.12900
Christie D, Thompson R, Sawtell M, et al. Effectiveness of a structured educational intervention using psychological delivery methods in children and adolescents with poorly controlled type 1 diabetes: a cluster- randomized controlled trial of the CASCADE intervention. BMJ Open Diabetes Res Care 2016;4(1):e000165. https://doi.org/10.1136/bmjdrc-2015-000165
Winocour PH. Transition or transfer of care of young adults with diabetes: more than semantics and a challenge for adult diabetes care? Poster Presentation at ‘Transition: developmentally appropriate care for young people with long term conditions’. RCP London Meeting, October 2015.
Maahs DM, Hermann JM, Holman N, et al. Rates of diabetic ketoacidosis: international comparison with 49,859 pediatric patients with type 1 diabetes from England, Wales, the US, Austria and Germany. Diabetes Care 2015;38:1876–82. https://doi.org/10.2337/dc15-0780
Zhong VW, Juhaeri J, Mayer-Davies EJ. Trends in hospital admission for diabetic ketoacidosis in adults with type 1 and type 2 diabetes in England, 1998–2013: a retrospective cohort study. Diabetes Care 2018; 41:1870–7. https://doi.org/10.2337/dc17-1583
Peyrot M, Rubin RR, Lauritzen T, et al, on behalf of the International DAWN Advisory Panel. Psychosocial problems and barriers to improved diabetes management: results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) study. Diabet Med 2005;22:1379–85. https://doi.org/10.1111/j.1464-5491.2005.01644.x
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