Diabetes care provision: barriers, enablers and service needs of young adults with type 1 diabetes from a region of social disadvantage

Aims To determine the barriers to and enablers of engaging with specialist diabetes care and the service requirements of young adults with Type 1 diabetes mellitus from a low socio-economic, multicultural region. Methods A cross-sectional survey targeted 357 young adults with Type 1 diabetes, aged 18?30 years. Participants completed questions about barriers/enablers to accessing diabetes care and service preferences, self-reported HbA1c , plus measures of diabetes-related distress (Problem Areas in Diabetes), depression/anxiety (Hospital Anxiety and Depression Scale), and illness perceptions (Brief Illness Perceptions Questionnaire). Results Eighty-six (24 ) responses were received [55 (64 ) female; mean SD age 24 4 years; diabetes duration 12 7 years; HbA1c 68 16 mmol/mol (8.4 1.5 )]. Logistical barriers to attending diabetes care were reported; for example, time constraints (30 ), transportation (26 ) and cost (21 ). However, `a previous unsatisfactory diabetes health experience? was cited as a barrier by 27 . Enablers were largely matched to overcoming these barriers. Over 90 preferred a multidisciplinary team environment, close to home, with after-hours appointment times. Forty per cent reported severe diabetes-related distress, 19 reported moderate-to-severe depressive symptoms and 50 reported moderate-to-severe anxiety. Conclusions Among these young adults with Type 1 diabetes, glycaemic control was suboptimal and emotional distress common. They had identi?able logistical barriers to accessing and maintaining contact with diabetes care services, which can be addressed with ?exible service provision. A substantial minority were discouraged by previous unsatisfactory experiences, suggesting health providers need to improve their interactions with young adults. This research will inform the design of life-stage-appropriate diabetes services targeting optimal engagement, access, attendance and ultimately improved healthcare outcome