Care delivery in youth with type 2 diabetes - are we meeting clinical practice guidelines?

Background: Studies indicate high rates of treatment failure and early onset diabetes-related complications in youth-onset type 2 diabetes (T2D). We aim to describe the quality of care provided to children and youth with T2D. Methods: This prospective cohort study used administrative datasets to describe individuals aged 10-24 yr diagnosed with T2D at < 20 yr of age (488 individuals; 2111 person-years). The primary outcome was being 'at goal' for adherence to Canadian clinical practice guidelines (CPGs). This was defined as having either optimal [three diabetes-related physician visits/year, three hemoglobin A1C (A1C) tests/year, and all recommended screening tests for complications (i. e., retinopathy, nephropathy)] or good (two diabetes-related physician visits/year, two A1C tests/year, and at least two screening tests) adherence to CPGs. Descriptive statistics and logistic regression modeling were used. Results: Sixty eight percentage person-years had poor adherence to CPGs (< 2 physician visits and A1c tests/year and no screening tests). Only 29% and 25% were at goal for adherence in the 15-19 and 20-24 yr age groups, respectively. There was a 52% decreased odds of being at goal for adherence 4 yr after diagnosis of T2D (p< 0.001). For every year increase in age at diagnosis, there was a 5% decreased odds of being at goal (p= 0.04). Conclusions: Youth with T2D are not receiving high quality care, and older youth and young adults are particularly at risk. Future research is needed to understand the effectiveness of care in the context of poor adherence as well as patient, physician, and health system factors that might improve adherence.