First national audit of the outcomes of care in young people with diabetes in New Zealand: high prevalence of nephropathy in Maori and Pacific Islanders.
BACKGROUND
Diabetes is an important cause of morbidity and mortality amongst young people. Despite improvements in technology, maintenance of good glycaemic control is hard to achieve.


METHODS
In July 2003, 12 paediatric and adult hospital-based diabetes services across New Zealand were invited to take part in an audit of the process and outcomes of care. By March 2004, 9 centres had submitted data on 1282 (1117 with Type 1 diabetes, 105 with Type 2) children and young people born after 1 January 1978.


RESULTS
There were significant centre differences in terms of glycaemic control, rates of microvascular complications and complication screening. The group mean HbA1c was 9.1 plus and minus 0.3%. Amongst 789 people aged 16-25 years, the prevalence of retinopathy was 12.8% (range 0-26%); nephropathy was 17.1% (range 7-28 %). Of those with a duration of diabetes <10 years, 25% had retinopathy and 27% nephropathy. Over the age of 12, microalbuminuria was more common amongst Maori and Pacific Islanders (43.8%) compared to Europeans (17%) or Others (17.8%). This was independent of the type of diabetes.


CONCLUSIONS
This is the largest study of young people with diabetes undertaken in New Zealand. The results confirm the difficulty of achieving good glycaemic control in children and young adults. Microvascular complications were common, particularly in those of long duration, and cardiovascular risk factors were present in many young adults. The difference in average HbA1c% between centres was highly significant and independent of other factors. Type 2 diabetes mellitus in young people was associated with early onset nephropathy and dyslipidaemia (almost from diagnosis), thus suggesting the need for earlier diagnosis.
Scott
Adrian
A
Waikato Hospital, Hamilton. adrian.scott@sth.nhs.uk
Toomath
Robyn
R
Bouchier
David
D
Bruce
Raymond
R
Crook
Nic
N
Carroll
David
D
Cutfield
Rick
R
Dixon
Paul
P
Doran
John
J
Dunn
Peter
P
Hotu
Cheri
C
Khant
Maunt
M
Lonsdale
Maureen
M
Lunt
Helen
H
Wiltshire
Esko
E
Wu
Denise
D
D000293:Adolescent; D000328:Adult; D000419:Albuminuria / Q000208:ethnology; D001786:Blood Glucose; D048909:Diabetes Complications / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000208:ethnology; D003930:Diabetic Retinopathy / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008485:Medical Audit; D009520:New Zealand / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D015995:Prevalence
D001786:Blood Glucose; D006442:Glycated Hemoglobin