Advice on using social media, texts and Skype to keep young people engaged in treatment for their diabetes has been published as part of wider information to help commissioners improve care transition.

NHS England has produced a new service specification to help improve services for young people transferring from child to adult services or from one service to another geographically.

There are currently 27,000 children and young people in England with Diabetes, 96 per cent of whom have Type 1.

Evidence shows the longer between appointments the higher the chance of a young person developing psychosocial issues such as anxiety and depression and increased HbA1c. Diabetes is also linked to higher rates of eating disorders.

The Diabetes Transition Service Specification is designed to inform commissioners’ development of a clear specification based on local context.

Dr Jackie Cornish, NHS England’s National Clinical Director for children and young people, said: “Making sure children and young people understand their condition and know how to effectively manage it through life is one of the most important elements of care because this reduces the likelihood of complications later in life.

“When young people move services it is one of the most challenging times and we know from evidence this is often a point when they disengage or lose interest in attending. This guidance is based on the best evidence available and we urge commissioners to use it when developing their local plans.”

Each service specification should include three key stages of transition the guidance says: paediatric preparation, planned transfers and supported integration into adult and new care settings.

The NHS outcomes framework measures as well as locally defined outcomes and measures should also form part of the local plans.

Some examples of measures which could be used include:

• Providing transition and young adult services that use technologies such as social media, email, texts, apps and Skype to reduce disengagement and promote uptake of services.
• Provision of a joint agreed care plan before transfer to next service.
• Agreed goals for the individual.
• Number of visits young person has attended in adult care monitored.
• DNA rates at clinics monitored.
• Preventing complications.
• Measurement of HbA1c levels every 3-6 months in CYP.
• Reduced unplanned hospital admissions between ages 13 and 25 monitored.
• Young people offered screening for a variety of conditions.
• Monitor nine key care processes including weight over time to monitor indications of an eating disorder.
• Provide a range of educational modules to help with understanding.

Around £10billion is spent every year on diabetes care – around 10 per cent of total NHS spend. Complications increase costs by five and the chance of a hospital admission by five.

There are 350 million people with diabetes worldwide, including over four million in the UK. Around 90 per cent of those with diabetes in the UK have Type 2 diabetes, and 10 per cent Type 1. Type 2 diabetes can be prevented through healthy lifestyle, Type 1 diabetes cannot. Type 2 diabetes prevalence is rising significantly every year and is tracking the population rise in obesity.

In those who avoid complications life expectancy is good and death rates continue to fall but for those with type 1 mortality is 131 per cent greater than the general population.

Professor Jonathan Valabhji, NHS England National Clinical Director for obesity and diabetes, said: “Diabetes and the treatment of its complications are a significant issue for the NHS. The transition from childhood and parental supervision to adulthood and independence can be particularly difficult for many young people with diabetes.

“This is a time when the traditional paternalistic model of healthcare delivery doesn’t suit all. We are therefore encouraging commissioners to explore the role of social media in the interactions between these young people and their healthcare professionals. But this is just one point of many in this comprehensive specification which we hope will guide local plans and help improve services for these patients.”

The guidelines were developed in conjunction with a young people’s diabetes forum who gave their views on the best ways to engage with different age groups through experience.

See also: Newham diabetes Skype pilot success increases young people’s clinic attendance