Diagnosis and management of type 2 diabetes in youth in North Queensland and the Northern Territory: A health professional survey

Abstract

Objective: To describe clinician practice regarding diagnosis, management and perceived barriers to the optimal management of youth-onset type 2 diabetes mellitus in North Queensland and the Northern Territory and to compare self-reported practice to guideline recommendations. Design: A mailed questionnaire distributed between July and October 2017. Setting: Clinicians practising in three tertiary hospitals and two primary care organisations in North Queensland and the Northern Territory. Participants: Of the 72 participants, 42 (58%) who responded were endocrinologists, diabetes educators, GPs and paediatricians. Results: Of the 42 clinicians, 23 referred to the guidelines. A diabetes educator, GP, endocrinologist and dietitian were the most commonly included clinicians in the multidisciplinary team. Half of the clinicians' screen the children if additional risk factors are present. The HbA1c is the most common test used for screening and diagnosis. At diagnosis, the clinicians' recommended lifestyle change in 86% of the patients, treatment with metformin in 48%, and, when indicated, treatment with insulin in up to 45%. All clinicians believe that non-adherence is a major factor limiting optimal care. Most commonly cited barriers to optimal care were poor patient or family health literacy and limited patient or family understanding of the condition. Conclusion: This study demonstrates several aspects of diagnosis and management of type 2 diabetes mellitus in youth that deviate from the guidelines. Patients need improved access to social workers, psychologists and Indigenous health workers. Other key areas to address are evaluation of risk-based screening, supporting appropriate and early use of insulin and the management of youth with type 2 diabetes mellitus inclusive of their family through contextualised health care delivery.