Early Onset Type 2 Diabetes (EOT2D)

Early Onset Type 2 Diabetes (EOT2D) is defined as the development of type 2 diabetes below the age of 40 years

EOT2D:

• Is more common in people from ethnic minorities (particularity in people with South Asian ethnicity) and people living in the most socio-economically deprived areas
• A high proportion of people with EOT2D are living with obesity and may also have concurrent unmet psychological and social needs
• Estimated to be an average of ~2,150 adults with EOT2D in Coventry and Warwickshire ICS geography, the majority of whom are cared for exclusively in General Practice, with an average of ~20 adults with EOT2D per GP practice
• Is associated with a more aggressive phenotype than older-onset type 2 diabetes, including more rapid progression of glycaemia, and earlier complications with significant reduction in life expectancy. Despite this, people with EOT2D are less likely to receive all recommended care processes and tend to have higher HbA1c levels than people with older-onset type 2 diabetes
• preparation for pregnancy and pregnancy outcomes are also poorer

What is expected of Primary Care with respect to EOT2D is to formally identify and review patients with EOT2D within their practices

Preparation for the review:

• Identify patients with type 2 diabetes on the practice register who are aged 18-39 years of age
• Ensure that baseline information is available at the time of the review (NICE-recommended annual care processes should be completed, and up-to-date values of relevant measures obtained (e.g., re-checking HbA1c prior to review, particularly if there has been an intervening change to glucose-lowering medication or last HbA1c was checked > 6 months ago)

Principles of the review:

The reviews will consider 4 key elements:

1) Classification of diabetes type – is this Type 2 diabetes?

2) Contraception and planning for possibility of pregnancy

3) Optimisation of glycaemia, cardiovascular risk, and weight

4) Psychological wellbeing and unmet social needs

The OneLTC Diabetes template (TM00191) is available via Primary Care IT – it records data and prompts specific interventions

More details can be found in the attachments