title: Service usage and vascular complications in young adults with type 1 diabetes.
abstract: BACKGROUND
  Few studies have examined young adults with type 1 diabetes use of health services and the development of vascular complications. As part of the Youth Outreach for Diabetes (YOuR-Diabetes) project, this study identified health service usage, the prevalence and factors predictive of development of vascular complications (hypertension, retinopathy and nephropathy) in a cohort of young adults (aged 16-30 years) with type 1 diabetes in Hunter New England and the Lower Mid-North Coast area of New South Wales, Australia.
  
  
  METHODS
  A cross-sectional retrospective documentation survey was undertaken of case notes of young adults with type 1 diabetes accessing Hunter New England Local Health District public health services in 2010 and 2011, identified through ambulatory care clinic records, hospital attendances and other clinical records. Details of service usage, complications screening and evidence of vascular complications were extracted. Independent predictors were modelled using linear and logistic regression analyses.
  
  
  RESULTS
  A cohort of 707 patients were reviewed; mean (SD) age was 23.0 (3.7) years, with mean diabetes duration of 10.2 (5.8, range 0.2 - 28.3) years; 42.4% lived/ 23.1% accessed services in non-metropolitan areas.Routine preventative service usage was low and unplanned contacts high; both deteriorated with increasing age. Low levels of complications screening were found. Where documented, hypertension, particularly, was common, affecting 48.4% across the study period. Diabetes duration was a strong predictor of vascular complications along with glycaemic control; hypertension was linked with renal dysfunction.
  
  
  CONCLUSIONS
  Findings indicate a need to better understand young people's drivers and achievements when accessing services, and how services can be reconfigured or delivered differently to better meet their needs and achieve better outcomes. Regular screening is required using current best practice guidelines as this affords the greatest chance for early complication detection, treatment initiation and secondary prevention.
authors.forename: Steven
authors.initials: S
authors.lastname: James
authors.affiliation: University of Technology, Sydney, 15 Broadway, Ultimo, New South Wales 2007, Australia. Lin.Perry@uts.edu.au.
authors.forename: Lin
authors.initials: L
authors.lastname: Perry
authors.forename: Robyn
authors.initials: R
authors.lastname: Gallagher
authors.forename: Julia
authors.initials: J
authors.lastname: Lowe
authors.forename: Janet
authors.initials: J
authors.lastname: Dunbabin
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.forename: Shamasunder
authors.initials: S
authors.lastname: Acharya
authors.forename: Katharine
authors.initials: K
authors.lastname: Steinbeck
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000517:prevention & control* / Q000523:psychology; D003928:Diabetic Nephropathies / Q000209:etiology* / Q000517:prevention & control; D003930:Diabetic Retinopathy / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult