Department of Diabetes & Endocrinology, Campbelltown Hospital, Campbelltown, NSW, Australia.
Macarthur Clinical School, Western Sydney University, Campbelltown, NSW, Australia.
BMC Endocr Disord. 2022 May 31;22(1):143. doi: 10.1186/s12902-022-01057-9.
To describe clinic management and referral pathways among adults with type 1 diabetes (T1D) aged > 25 years attending a public outpatient diabetes service.
Retrospective cohort study of people with T1D aged > 25 years seen by endocrinologists in one Australian urban public outpatient in 2017. Electronic and paper medical records were reviewed using a dataset adapted from the UK National Institute for Health and Care Excellence 2015 guidelines.
Among the 111 people with T1D (mean age 41 ± 13 years, 55% men, mean body mass index 27.1 ± 5.6 kg/m), mean HbA1c was 8.1 ± 1.9% (66 ± 19 mmol/mol) (lower than the Australian National Diabetes Audit: 8.5%/69 mmol/mol) with 25.5% meeting the guideline target of < 53 mmol/mol (7.0%). Most people had seen a diabetes educator (80.2%) or dietitian (73.0%) and had complication screening. Complication rates were high (nephropathy 20.4%, retinopathy 27.4%, peripheral neuropathy 30.1%, ischaemic heart disease/acute infarction 10.5%). Overall, 27% of referrals occurred following an acute inpatient admission or emergency department presentation and 13% for management of diabetes in pregnancy.
A high proportion of people with T1D accessed public specialist care either during pregnancy or after a largely avoidable acute glycaemia-related hospital presentation. Subsequent care was in line with national specialist standards. This area has a "wait for acute event" rather than "complication prevention" model of care, associated with under-referral to the local multidisciplinary specialist service. Understanding how widespread this model of care is, and ways to reduce its prevalence, are urgently required.
描述在一家澳大利亚公立门诊糖尿病服务机构就诊的年龄大于 25 岁的 1 型糖尿病（T1D）成人的临床管理和转诊途径。
这是一项对 2017 年在澳大利亚一家城市公立门诊就诊的年龄大于 25 岁的 1 型糖尿病患者的回顾性队列研究。研究使用了从英国国家卫生与保健卓越研究所 2015 年指南改编的数据集中的电子和纸质病历进行了回顾。
在 111 名 T1D 患者中（平均年龄 41±13 岁，55%为男性，平均体重指数 27.1±5.6kg/m²），平均 HbA1c 为 8.1±1.9%（66±19mmol/mol）（低于澳大利亚国家糖尿病审计：8.5%/69mmol/mol），有 25.5%的患者符合<53mmol/mol（7.0%）的指南目标。大多数患者都看过糖尿病教育者（80.2%）或营养师（73.0%）并进行了并发症筛查。并发症发生率较高（肾病 20.4%、视网膜病变 27.4%、周围神经病变 30.1%、缺血性心脏病/急性心梗 10.5%）。总体而言，27%的转诊发生在急性住院或急诊科就诊后，13%的转诊是为了妊娠期间的糖尿病管理。
相当一部分 T1D 患者要么在怀孕期间，要么在很大程度上可避免的急性高血糖相关住院就诊后，接受了公共专科护理。随后的护理符合国家专科标准。该地区存在“等待急性事件”而不是“预防并发症”的护理模式，与向当地多学科专科服务的转诊不足有关。迫切需要了解这种护理模式的广泛程度以及减少其流行率的方法。
