Young adults with type 1 diabetes are ‘a hugely vulnerable group of patients', a leading doctor has claimed.

According to Dr Kevin Moore, a consultant endocrinologist at Tallaght Hospital and Naas General, adolescence is a minefield even in normal circumstances. However, when diabetes is added to the mix, this can result in major challenges, particularly as the young person transitions into adult care.

He pointed to an audit his department at Tallaght Hospital carried out a few years ago, which looked at 54 patients attending the young adult clinic there.

Type 1 patients in Tallaght normally transition to regular adult care at the age of 24, prior to which they attend this young adult clinic. The average age of patients in this clinic was found to be around 21, while the average age at the time of their diagnosis was 12.

The audit revealed that the attendance rate at the clinic was very poor and average HbA1c measurements were too high. HbA1c is a measurement of how well a person's diabetes has been controlled in the previous two to three months. If this figure is too high, this indicates poorly controlled diabetes.

Dr Moore pointed out that similar findings have been noted in other countries and he said there are many reasons for this.

"In short, being a young adult is hard, but being a young adult with diabetes is really hard," he commented.

Some young people feel anxious or depressed about having type 1 diabetes and some have not yet come to terms with having the condition.

Dr Moore noted that there are repercussions when diabetes is poorly controlled. For example, data from Galway and Sheffield in the UK suggested that a major proportion of young type 1 patients already had some degree of diabetic retinopathy (eye disease) and hypertension (high blood pressure).

Studies have also found significant death rates among young adults with type 1 diabetes, some of which are due to preventable complications.

Dr Moore admitted that this is a difficult area for healthcare professionals and currently, there is simply not enough research data to help professionals understand what needs to be done for these particular patients.

One of the complex issues professionals face is the fact that in many cases, young people do not think they have a problem, however the data shows otherwise.

Dr Moore said that ideally, every young adult with type 1 diabetes should have the opportunity to attend a ‘transition clinic', preferably in the paediatric setting. Here, they would be seen by a consultant and specialist nurse who would help that patient bridge the gap between paediatric and adult services.

"Healthcare professionals should understand the difficulties that young adults face trying to manage their condition. Communication skills and an ability to motivate patients is key when dealing with young adult type 1 patients," he commented.

Also ideally, all adult diabetes centres should have a professional who oversees the care of young adult patients who are transitioning to adult services.

Meanwhile, Dr Moore also noted that ‘it is really essential that our patients have access to psychology services when needed, and that currently isn't the case'.

"These are a hugely vulnerable group of patients but the reality is that we are just not doing well enough in managing them, in terms of HbA1c levels, non-compliance with treatment, and disengagement and drop-outs from services, which are major issues," he said.

He called for adequate resources to be allocated to young adult diabetes services.

Dr Moore made his comments at a Diabetes Ireland paediatric study day, details of which were published in the journal, Professional Diabetes & Cardiology Review.