Key Needs Identified for Early-Onset T2D Health Care Service

TOPLINE:

Based on the literature and stakeholder input, the authors have identified barriers to care for people with early-onset type 2 diabetes (EOT2D) and have proposed elements of a health delivery service specifically for those individuals.

METHODOLOGY:

• A literature search was undertaken to identify important considerations.
• A working group of key stakeholders was formed to design a triage system and service pathway.
• Electronic medical records (EMRs) were searched to assess feasibility of the pathway and adapt accordingly.

Important factors identified and proposed solutions include the following:

• High risk for diabetes complications and reduced life expectancy.
  • A bespoke specialist clinic with a focus on intensive cardiovascular risk factor management and psychiatric comorbidity.
  • Development of “red, amber, green” criteria to determine the risk level.
  • Inclusion of these factors into a healthcare provider education module.
• A lack of data for effective interventions and pharmacotherapies and a large proportion of pregnant women on teratogenic medication.
  • Consider tirzepatide in people with raised glucose and weight.
  • Closely follow guidelines for intensification of medication for other complications such as hypertension and dyslipidaemia.
  • Caution women about teratogenicity of medications and recommend concurrent contraception in clinics.
  • Discuss treatment options in pre-pregnancy clinic for women planning pregnancy.
• Low attainment of national diabetes targets probably to result in EMRs with missing clinical data.
  • Extra assistance to practices with high numbers of patients who may be struggling with access to healthcare.
  • Communications with practices and sharing of searches to allow quick identification of patients with miscoding.
• A greater proportion of people from minority ethnic and more socioeconomically deprived backgrounds.
  • Recognition of potential for language and/or cultural barriers.
  • Clinical services with reach into all communities and with cultural/gender acceptability.
• Psychological factors including diabetes distress, adverse eating behaviours, and depression.
  • A module built into healthcare professional (HCP) education highlighting these factors.
  • Possible future need for more formal pathways for psychological/ psychiatric management.
• Social factors including busy lives, stigma, poor access to healthcare, inflexible working environments, and strong diabetes family history.
  • A module built into HCP education highlighting these factors.
  • Flexible timing of bookings for bespoke specialist clinic, including evening appointments and virtual/telephone consultations.
• Poor diagnostic coding.
  • Review of patient records to correct coding, including further investigation (e.g. c-peptide/ autoantibodies) as needed.

IN PRACTICE:

“There is a clear need for interventions to reduce the risk of complications in people with EOT2D; however, a lack of evidence on how best to achieve this. Ongoing and future research may provide evidence-based interventions specific for people with EOT2D, but these will take years to materialise. In the meantime, initiatives like the T2Day Programme are vital, as a lack of intervention is likely to have significant implications on both public health and national finances, given the rising prevalence and increased morbidity of EOT2D in working-age adults,” the authors wrote.

SOURCE:

Conducted by Jonathan Goldney, of the Diabetes Research Centre, University of Leicester, and National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, UK, and colleagues, the service pathway was published online on November 25, 2024, in Diabetic Medicine.

LIMITATIONS:

Service pathway developed within the financial constraints of the T2Day funding.

DISCLOSURES:

The service design was funded by NHS England T2Day program by the Leicester, Leicestershire, and Rutland Integrated Care Board. The study was supported by the National Institute of Health Research (NIHR) Leicester Biomedical Research Centre. Jonathan Goldney was supported by the Wellcome Trust Leicestershire Healthcare Inequalities Improvement Doctoral Training Programme. One co-author was co-funded by the NIHR Leicester Biomedical Research Centre and University of Leicester, and had acted as consultant, advisory board member, and speaker for, and/or received grants from Boehringer Ingelheim, Eli Lilly, Novo Nordisk, and Sanofi; an advisory board member of Pfizer, AstraZeneca, Zealand Pharma, Carmot/Roche, Amgen, and Medtronic; and as a speaker for AstraZeneca and Amgen. The other authors declared no conflicts of interest.