Adolescent and Young Adult Type 1 Diabetes Audit (AYA), 2017-21

Diabetes is a condition where the amount of glucose in the blood is too high because the pancreas doesn’t produce enough insulin.  Insulin is a hormone produced by the pancreas that allows glucose to be used as a body fuel and other nutrients to be used as building blocks. There are 2 main types of diabetes: type 1 diabetes (no insulin); type 2 diabetes (insufficient insulin).

This is a service (often hospital based but sometimes delivered in a community setting) which includes diabetes specialists working in multidisciplinary teams. These teams usually comprise physicians (diabetologists), diabetes specialist nurses and dieticians; it may also include clinical psychologists.

Insulin pump or Continuous Insulin Infusion therapy uses rapid acting insulin delivered subcutaneously under the control of a ‘Pump’. Background rates are programmed and mealtime boluses are added manually.

For the purposes of this report adolescents are people aged 15 to 18 years old. Young adults are people aged 19 to 25 years old (inclusive).

Blood Pressure is a measurement of the force driving the blood through the arteries. Blood pressure readings contain 2 figures, e.g.130/80. The 1st is known as the systolic pressure which is produced when the heart contracts. The 2nd is the diastolic pressure which is when the heart relaxes to refill with blood.

BMI measurement - Body Mass Index (BMI) is calculated from weight and height. Methods differ between children (up to 18 years old) and adults. In adults, categories are assigned on BMI ranges. For children, their BMI is compared to reference values for children of the same sex and similar age that took part in national surveys. Assignments for both groups are:

Serum creatinine - this is a blood test used to measure kidney function.

Urinary albumin - this urine test detects the earliest stages of kidney disease.

Cholesterol - this blood test measures a type of fat that can damage blood vessels. This is not a mandated care process for adolescents and young adults.

Foot check/exam - this examination checks the blood supply and sensation (feeling) in the feet. Loss of either is a risk for foot disease.

Smoking Status - this records whether the person is a smoker. Smoking increases the diabetic risk for heart attacks and stroke.

HbA1c - this is a blood test for average blood glucose levels during the previous 2 to 3 months.

UACR is a ratio between 2 measured substances urine albumin and urine creatinine. Unlike a urine dipstick test for albumin, UACR is unaffected by variation in urine concentration.

HbA1c - the closer this is to normal (less than 42mmol/mol) the lower is the risk of all long term complications of diabetes.

Cholesterol - reducing cholesterol levels lowers the risk of heart attacks and strokes.

Blood Pressure - high levels are a risk for heart attacks and strokes; they also drive progression of eye and kidney disease.

It is a potentially life-threatening complication of predominantly type 1 diabetes that occurs when insulin levels become very low. As a result of the lack of insulin the body is unable to store or use blood sugar (glucose) which rises uncontrollably. Fat is broken down to use as an alternative energy source but in an uncontrolled fashion. This causes a build-up of potentially harmful, acidic, ketones. The high glucose and ketone levels lead to excessive urination, vomiting, dehydration, low blood pressure and collapse/coma. Without treatment DKA is fatal.