Developing services to support the delivery of care to people with early‐onset type 2 diabetes

Abstract

Early-onset type 2 diabetes occurring in childhood or early adulthood carries a significant excess burden of microvascular diabetes complications, cardiovascular disease and premature death, compared to later onset type 2 diabetes along with adverse pregnancy outcomes in women of child-bearing age. National audit data in England reveal that 122,780 individuals under the age of 40 years are currently living with type 2 diabetes, with an over-representation of people from minority ethnicities and those in the most socioeconomically deprived quintiles. A diagnosis of type 2 diabetes earlier in life poses some unique challenges to healthcare providers that are not routinely encountered when type 2 diabetes presents later. These include; (1) the need to ensure correct diabetes classification in an age group that carries a higher probability of other types of diabetes, (2) overcoming difficulties in engaging with individuals who are of working age or in fulltime education, (3) appreciating and addressing the lower attainment of diabetes treatment targets and (4) proactively supporting women of child-bearing age to optimise their future pregnancy outcomes through better preparation for pregnancy, including achieving optimum glycaemic control at the time of conception. Meanwhile, approaches to prevent type 2 diabetes in younger age groups are challenged by difficulties in identifying those at highest risk, by poorer attendance at lifestyle interventions to prevent or delay the onset of type 2 diabetes and by attenuation of associated weight loss in those that do attend. In this article, we discuss the importance of recognising and addressing the distinct challenges in delivering healthcare to those with early-onset type 2 diabetes, the greater challenges in preventing type 2 diabetes at younger ages, and key components of strategies that might address these challenges to drive improvements in pregnancy outcomes, microvascular and cardiovascular outcomes.

Characteristics and care of young people with type 2 diabetes included in the national diabetes audit datasets for England

“…These approaches must include a focus on strategies that engage people of working age, women of child‐bearing age and indeed those that are tailored to people from deprived communities of any ethnic group and those from minority ethnic groups. 30 …”

“…Irrespective of the underlying drivers for poor outcomes, these results suggest there will be a need for novel approaches to care provision in those living with type 2 diabetes under the age of 40 years. These approaches must include a focus on strategies that engage people of working age, women of child‐bearing age and indeed those that are tailored to people from deprived communities of any ethnic group and those from minority ethnic groups 30 …”

Diabetes knowledge, self‐efficacy and dietary, psychological and physical health barriers: Comparing young and usual‐onset type 2 diabetes

“…A meta‐analysis of behavioural interventions aimed at improving self‐management in young adults with type 1 and 2 diabetes found that glycaemic levels did not significantly improve, 8 contrasting with the positive findings from systematic reviews conducted in type 2 diabetes in general 9 . A recent review has emphasized the need for better engagement and novel approaches for self‐management in YOD 10 …”

“…9 A recent review has emphasized the need for better engagement and novel approaches for selfmanagement in YOD. 10 The American Association of Diabetes Educators (AADE) described the main factors impacting selfmanagement and categorised them as knowledge, skills and barriers. 11 Diabetes knowledge is fundamental to self-management.…”

Fuelling inequality

“…Health inequalities are prevalent, complex and represent a significant barrier to public health. Deprivation is a significant factor for access to type 1 diabetes technologies 1 and for the effectiveness of education interventions 2 while the importance of addressing health inequalities to optimise outcomes for those at greatest risk is critical when developing services to support the delivery of care to people with early‐onset type 2 diabetes 3 . Importantly, while the use of type 1 diabetes technologies is related to deprivation, outcomes are not, suggesting that institutional, infrastructure and individual factors at the healthcare provider level should be addressed to remove inequalities.…”