Summary
Young adults with type 2 diabetes (T2D) face worse outcomes than older adults, yet NHS services are not designed for their needs. A community-based service for 19–24-year-olds with T2D was established, offering holistic, youth-friendly, non-judgemental, multidisciplinary care. A dedicated youth-specialist health and wellbeing practitioner (YSH&WP) conducted personalised outreach to support engagement. A co-designed group-based psychosocial educational support programme, ‘Type 2 Take 2’ (T2T2), was piloted alongside the clinic. The pathway supported engagement with diabetes care and self-management among a underserved population, demonstrating HbA1c reduction without BMI increase and higher completion of eight diabetes care processes.
Innovation/Novel approach to an existing problem
T2D prevalence is rising rapidly in younger adults, but there is no tailored support. In February 2023 a new care pathway for young adults was introduced in Southwark and Lambeth. This dedicated service is community (rather than hospital)-based, with a welcoming, non-judgemental multidisciplinary team (MDT). A YSH&WP undertakes targeted outreach. There is two-way communication using a dedicated mobile number and preferred communication methods. A proactive approach is taken for those who do not attend appointments. The T2T2 group-based psychosocial educational support programme was co-designed and piloted. The aims were to increase the proportion receiving care in a young adult service, increase the numbers completing the eight key diabetes care processes, reduce HbA1c and body mass index (BMI) and improve patient experience of care.
Equality, Diversity and Variation
The new care pathway was developed to address inequalities in access, experience, and outcomes for young adults with T2D in a population where 50% of 19–24-year-olds with T2D are Black, 19% White and 12% Asian, and 71% live in the two most deprived national quintiles. The YSH&WP uses WhatsApp, text, phone, email and/or in-person outreach tailored to each patient. He has supported young people from diverse ethnic, cultural, and educational backgrounds to attend the clinic for the first time, and works with individuals with learning disabilities, neurodivergence, and mental health needs, providing tailored support. Care is adapted to cultural and individual needs. T2T2 offers an alternative to didactic information-giving, using activity-based sessions and peer discussion and has been attended by those who previously did not engage with diabetes care. Outcomes include increased engagement in routine care, improved confidence, healthier eating and increased physical activity.
Impact to Patient Care
The MDT includes diabetes doctors, nurses, dietitians, and a YSH&WP, all with experience and interest in working with young people. Clinics are located in community settings and are exclusively for young adults with T2D. They are offered face-to-face appointments every 2–6 months according to need. At each visit, the young adult usually sees one healthcare professional plus the YSH&WP, but may also see other MDT members. Individualised care plans are created. Patient care plans are discussed at MDT meetings. Between-clinic telephone or email support is offered. The MDT and YSH&WP signpost and support young adults to access mental health provision locally. The YSH&WP is a consistent point of contact. The team works with primary care to advertise the service and encourage referrals. The MDT undertakes proactive case management for those who do not attend appointments including reviewing data to assess risk and care gaps, plus targeted messaging. Improved access and engagement have been major achievements. T2T2 has consistent core staff to support trust and continuity, with additional input from a psychologist, chef, diabetes specialist nurse, and diabetes doctor. It provides education through interactive, activity-based sessions. The clinic and T2T2 programme have improved access, engagement, behavioural and clinical outcomes, while also addressing psychosocial needs.
Results
The proportion of the target cohort who had attended at least one appointment in young adult service increased from 37% in February 2023 to 83% by May 2025, a more than twofold increase. Regarding completion of the eight key diabetes care processes (CPs), of 35 young adults under the Southwark service (April 2024-March 2025), 60% completed all eight CPs within that year compared to 42% in the South East London Integrated Care System (SELICS) (2021-2022). For individual care processes, completion rates were: HbA1c 100% (SELICS 82.6%); BMI 100% (SELICS 82.6%); blood pressure 100% (SELICS 82.6%); urine albumin/creatinine ratio 80% (SELICS 58%); foot risk surveillance 82.9% (SELICS 63.8%); serum creatinine 80% (SELICS 76.8%); smoking status 91.4% (SELICS 88.4%), with only completion of serum cholesterol lower (68.6% [SELICS 75.4%]). Among 66 young adults who attended at least two appointments and had been under the service for at least six months, median HbA1c decreased from 62 to 48 mmol/mol (p=0.0013). Median BMI was 34.2 kg/m2 at first visit and 32.7 kg/m2 at most recent visit. This shows meaningful improvements in glycaemic control with no increase in BMI. Psychosocial and behavioural outcomes also improved. Among 14 participants who engaged with the step-counting app, average weekly steps increased by 33%. Participants reported positive changes in diet, cooking, and physical activity, supported by culturally inclusive advice. Participants described feeling less isolated, more confident, and more engaged with care. This service is now embedded as usual care in Southwark and Lambeth, with ongoing work with SELICS to secure long-term sustainability.
User Feedback
User feedback has been central to development, delivery, and ongoing improvement of the service and T2T2 programme. Multiple feedback mechanisms were used: 1:1 interviews with 10 young adults with T2D, conducted by an independent researcher; co-design workshops with 16 young adults with T2D; a focus group to refine priorities; a post-T2T2 sessions feedback form; ongoing informal verbal WhatsApp message feedback via the YSH&WP. Feedback has consistently highlighted the value of the non-judgemental, youth-friendly approach and the sense of safety created in both clinic and T2T2. Many described this as a significant departure from previous care experiences. Young adults described T2T2 as a welcoming, informative and socially supportive experience. Participants valued the opportunity to meet others their age with T2D, reducing feelings of isolation. Some participants stayed in touch after the programme, which had fostered ongoing motivation and accountability. Feedback was used in real time to adapt both the clinic model and T2T2. Co-design participants shaped the T2T2 programme curriculum, prioritising topics that addressed their challenges.
