P-41: Utility of a comprehensive care clinic for youth-onset type 2 diabetes
J Bays, J Johnson, C Aston, K Jeter, M George, R Allen, J Beck, J TryggestadAbstract
Introduction
Youth-onset type 2 diabetes (YOT2D) has increased rapidly over the last 20 years with rapid beta cell failure leading to treatment failure and complications. In January 2020, a comprehensive care model (CCM) was established that included two dedicated physicians, a physician extender, a psychologist, and a rotation of Certified Diabetes Care and Education Specialists (CDCES®) including a pharmacist, registered dietitians and nurses.
Objectives
To examine the impact of a CCM for YOT2D on glycemic control as measured by Hemoglobin A1C (HbA1C), clinic appointment attendance, and completion of annual lipid and microalbumin screening before and after its initiation.
Methods
A retrospective cohort study was conducted at a single, academic medical center at the following time points: 1/1/2015-12/31/2019 (T1), 1/1/2020-5/31/2021 (T2), 6/1/2021-6/30/2025 (T3). The middle cohort included due to COVID-19. Statistical significance was determined by one-way ANOVAs, two sample t-tests, and Chi-squared tests with continuity correction.
Results
Mean HbA1C decreased from 7.9% [6.3%-10.4%] in T1 to 7.5% [6.4%-9.2%] in T3 (p=0.0035 by ANOVA). From T1 to T3, the completion of lipid assessment increased from 55.6% to 72.2%, and urine albumin screening increased from 48.3% to 63.3% (both p<0.0001 by Pearson’s Chi-squared test). While not reaching statistical significance, clinic attendance trended higher from 2.0 [2.0 - 3.0] in T1 to 3.0 [2.0 - 4.0] in T3 (p=0.069 by ANOVA). Use of GLP1-RA did not impact the HbA1C result (p=0.7), but it did impact clinic attendance, 3.4 ± 1.1 visits for those using GLP1-RA vs 2.5 ± 1.1 visits for those not using GLP1-RA (p<0.0001).
Conclusions
The implementation of a CCM for YOT2D demonstrated improved glycemic outcomes and increased completion of screening for macro and microvascular complications. The impact of the clinic on glycemic control was not mediated by GLP1-RA. Overall, the implementation of a CCM may be an avenue to improve glycemic control and prevent complications in YOT2D.