Publication, Part of National Diabetes Audit: Adolescent and Young Adults with Type 1 Diabetes
Adolescent and Young Adult Type 1 Diabetes Audit (AYA), 2017-21
Future publication format
Please note that future publications will be web-based only. This is to improve the accessibility of our publications.
16 June 2022 09:30 AM
Change to inclusion of drug prescription and diabetic ketoacidosis (DKA) data for Wales
In the Interactive data visualisation published on 16 June 2022 Wales drug prescription data was not included in the diabetes diagnosis validation process. In v2.0 of the visualisation this data has been included resulting in a larger cohort used for the analysis, particularly for Wales. For further details on the diagnosis validation process see main report.
In addition, v2.0 no longer includes analysis on DKA hospital inpatient admissions for Wales. This is because it was only possible to obtain data NHS hospital admission data from hospitals in England and therefore any DKA hospital inpatient admission results for Wales would not have been representative of diabetes care in Wales.
18 July 2022 09:00 AM
Changes to NDA reporting
NHS England are currently reviewing the routine production of NDA State of the Nation reports. Please note that data will still be released via dashboards and standalone data files whilst this review is being conducted.
To help inform this review we would be grateful if users can provide feedback on their use of the State of the Nation reports using the feedback survey available in the ‘Related links' section of this page.
3 June 2024 00:00 AM
Summary
The Adolescent and Young Adult Type 1 Diabetes Audit (AYA; previously referred to as the National Diabetes Transition Audit, NDTA) links datasets from the adult and paediatric national diabetes audits. The AYA has been designed to audit care provision during the period when young people with diabetes move from paediatric to adult based clinical care. The audit covers the period 01 January 2017 to 31 March 2021 and the cohort consists of people with type 1 diabetes aged between 15 and 25 years old during the AYA period.
The National Diabetes Audit (NDA) provides a comprehensive view of diabetes care in England and Wales. It measures the effectiveness of diabetes healthcare against National Institute for Health and Care Excellence (NICE) Clinical Guidelines and NICE Quality Standards*,**.
The National Paediatric Diabetes Audit (NPDA) was established to compare the care and outcomes of all children and young people with diabetes receiving care from Paediatric Diabetes Units (PDUs) in England and Wales.
At the time of producing this report the Welsh NPDA data was not available to NHS Digital. Therefore, to ensure timescales for publication of this population level report were met, only England data is included (94.7% of the combined data***). Welsh NPDA data has since become available meaning Welsh data is included in the national and locality level dashboard accompanying this report. Consequently, the combined England and Wales national results in the dashboard may be slightly different to the England national results in this report.
-* NICE Clinical Guidelines – NG17: Type 1 diabetes in adults: diagnosis and management http://www.nice.org.uk/guidance/ng17
** NICE – Diabetes in Adults Quality Standard http://guidance.nice.org.uk/QS6.
*** ONS 2020 mid-year population estimates for England and Wales.
Highlights
Recommendation 1
Adult services, both specialist and primary care, should develop systems to ensure that all adolescents and young adults continue to receive NICE recommended health checks after discharge from paediatric care.
Recommendation 2
Specialist paediatric and adult services should collaborate to develop systems of care that are aligned with the multiple life changes which accompany late adolescence/early adulthood in order to minimise age associated deteriorations in level of glucose control (15-20 years old) and frequency of diabetic ketoacidosis (15-18 years old).
Recommendation 3
Young adults with type 1 diabetes transferring from paediatric services and using insulin pump therapy should be supported by adult specialist services to continue and those who are eligible by NICE criteria should be offered insulin pump treatment.
Experts By Experience
Below are quotes from young adults with lived experience of type 1 diabetes and transferring from paediatric diabetes services to adult diabetes services:
Key Facts
Characteristics
There were more males than females (55.2% vs. 44.8%), and more than expected lived in areas of social deprivation.
BMI
The proportion of people who were living with overweight and obesity increased progressively from the age of 18 years old.
Care processes
Recorded completion of most annual, NICE recommended, care processes dropped steadily between the ages of 17 and 20 years and then plateaued. Low rates of Urine Albumin Creatinine Ratio (UACR) checks were notable at all ages.
Treatment targets
Mean/median HbA1c and the proportion of people achieving HbA1c treatment targets deteriorated steadily between the ages of 15 and 20 years old and improved steadily thereafter.
Transfer to adult services
For 15 to 20 year olds, the mean/median HbA1c was similar at all ages of leaving paediatric services.
Diabetic ketoacidosis
Diabetic ketoacidosis (DKA) frequency (single and multiple inpatient admissions with episode of DKA) started to rise at 16 years old, peaked at 18 years old and then fell slowly but progressively.
Insulin pump usage
81.9% of adolescents using insulin pumps continue to do so in young adulthood. Insulin pump usage rates dropped by almost two thirds (33.3% to 12.1%) between the ages of 15 and 25 years. At all ages pump users were more likely to achieve HbA1c treatment targets and less likely to experience DKA.
Resources
Last edited: 3 June 2024 10:34 am