Celebrating Diabetes Week 2026: reducing inequality in young adult diabetes care

Every Diabetes Week brings renewed focus on rising prevalence, mounting complications and increasing pressure on NHS services. These concerns are justified. But in young adult diabetes care, the central issue is no longer awareness alone. Persistent inequality in outcomes reflects a deeper problem: the way services are designed.

Too often, poor glycaemic control and recurrent admissions are interpreted through the language of ‘non-engagement’. Yet for many young adults, engagement is not a fixed personal characteristic. It is shaped by financial insecurity, mental health burden, educational or employment pressures, and fragmented transitions between paediatric and adult care. When outcomes vary so widely, we should question not only patient behaviour, but whether current systems are meeting the realities of young adult life.

If inequality persists despite advances in treatment and technology, it is reasonable to ask whether traditional models of care remain fit for purpose.

For the St Helens Young Adult Diabetes team, part of Mersey and West Lancashire Teaching Hospitals NHS Trust, a different model has focused on proactive risk management rather than reactive care. Young adults with persistently elevated HbA1c are identified early and supported through coordinated multidisciplinary input integrating medical, nursing, dietetic and psychological expertise. The aim is not simply to respond to deterioration, but to anticipate risk before crisis develops.

This work is strengthened by close collaboration with our inpatient diabetes colleagues, whose service has achieved level 1 accreditation through the Diabetes Care Accreditation Programme (DCAP) and is progressing towards level 2 accreditation. Joint working around the prevention and management of diabetic ketoacidosis (DKA), alongside shared quality improvement initiatives, helps ensure continuity of care across inpatient and outpatient settings.

The impact has been significant. Recurrent DKA admissions have fallen by around 80%, while clinic non-attendance has reduced from approximately 50% to below 17.8%. Median HbA1c has improved from around 68 mmol/mol to 58 mmol/mol. Although glycaemia alone is an imperfect marker of wellbeing, these outcomes suggest that sustained improvement is achievable when care is organised around continuity, accessibility and early intervention.

The integration of a dedicated psychological support pathway has also produced measurable benefits. Rates of moderate to severe mental health distress have reduced from 32% to 16%, reinforcing the close relationship between psychological wellbeing and diabetes outcomes. In young adults, mental health support should not be viewed as an optional addition to diabetes care, but as a core component of effective long-term management.

Prevention must also become a routine component of care rather than an aspirational extra. Improved uptake of diabetic retinal screening in historically under-served groups demonstrates what is possible when preventive care is embedded into routine pathways rather than left to individual patient capacity. Delivery of all nine NICE-recommended diabetes care processes has also remained consistently above national averages, highlighting the value of reliable systems and proactive follow-up.

Technology has strengthened diabetes care, but it is not a solution in isolation. Continuous glucose monitoring and hybrid closed-loop systems have transformed the ability to make timely, collaborative treatment decisions. However, without equitable access and structured support, innovation risks widening disparities rather than reducing them.

Across all these interventions, one principle remains consistent: outcomes improve when services are designed around patients’ lives rather than organisational convenience.

For physicians, the implications are clear. Improving outcomes in young adult diabetes may depend less on discovering new therapies and more on delivering existing care differently: proactively, consistently and responsively. Non-attendance should not be viewed simply as patient disengagement, but as a warning sign that services may be inaccessible, inflexible or poorly coordinated.

Diabetes Week should therefore do more than raise awareness. It should prompt a more difficult but necessary conversation about accountability. We already know that better outcomes are possible. The challenge now is whether healthcare systems are willing to redesign services in ways that make those outcomes achievable for all young adults living with diabetes.

AI disclosure statement: I used generative AI tools to support drafting and refinement of language. The clinical content, interpretation and final approval were my own.