Background: Twenty years ago (1992) Monash Medical Centre (MMC) established a Young Adult Diabetes Service (YADS), by providing a developmentally age appropriate transition clinic for 15-25 year olds, with twice monthly evening clinics (5-8pm). Initially the service was provided by a single Paediatric and Adult endocrinologist as a privatized clinic within MMC.
Observations: Within months the number of young people attending the clinic outgrew the capacity of the two consultants, warranting recruitment of additional consultants. Subsequently a multidisciplinary service was developed with additional healthcare professionals recruited and the clinic was transferred to the public outpatient clinic. The clinic now provides access, in a single hospital visit, to 4 paediatric endocrinologists, 1 paediatric and 1 adult diabetes nurse educator, 6 adult endocrinologists, a dietitian , a podiatrist, a social worker, a clinic nurse and a biochemist to perform point of care HbA1C, with access to pathology services and pharmacy with extended hours to minimise and simplify multiple separate appointments for young people.
Outcomes: This clinic now runs at capacity seeing up to 45 young people per clinic. Overall, patient numbers have stabilised at approximately 400 for the last 6 years. This represents less than half of the known T1DM in our Southern Health catchment. We have demonstrated continuity of care as 71% of those diagnosed within the paediatric service continue to attend YADS. From 2000 - 2008 the average clinic HbA1C decreased from 9.7% to 8.9% in the 15 – 19 year olds and from 9.2 to 8.7% in the 20 – 25 year olds.
Conclusion: We have demonstrated that this model of transition care is sustainable and effective in supporting young people to stay connected with their diabetes healthcare team, through adolescence into adult independence, reducing their risk of a life time of poor control and dependency on others.