Clinical and Psychosocial Outcomes of a Structured Transition Program Among Young Adults With Type 1 Diabetes

Abstract

Purpose We identified and treated young adults with type 1 diabetes who had been lost to follow-up during their transfer from pediatric to adult care, comparing their clinical, psychosocial, and healthcare utilization outcomes to participants receiving continuous care throughout the transition to adult care. Methods Individuals in their last year of pediatric care (“Continuous Care” group, CC, n=51) and individuals lost to follow-up in the transfer to adult care (“Lapsed Care” Group, LC, n=24) were followed prospectively for 12 months. All participants were provided developmentally tailored diabetes education, case management, and clinical care through a structured transition program. Results At baseline, LC participants reported lapses in care of 11.6 months. Compared to CC participants, they had higher A1C (p=0.005), depressive symptoms (p=0.05), incidence of severe hypoglycemia (p=0.005), and emergency department visits (p=0.004). At 12-month follow-up, CC and LC participants did not differ on the number of diabetes care visits (p=0.23), severe hypoglycemia (no events), or emergency department visits (p=0.22). Both groups’ A1C improved during the study period (CC p=0.03; LC p=0.02). LC participants’ depressive symptoms remained elevated (p=0.10), and they reported a decline in life satisfaction (p=0.007). There was greater loss to follow-up in the LC group (p=0.04). Conclusions Our study suggests that, for young adults with a history of lapses in care, a structured transition program is effective in lowering A1C, reducing severe hypoglycemia and emergency department utilization, and improving uptake of routine diabetes care. Loss to follow-up and psychosocial concerns remain a significant challenge in this population.

How can we support children, adolescents and young adults in managing chronic health challenges? A scoping review on the effects of patient education interventions

“…Differences in blood glucose control were measured in 15 studies. Of these, four studies found no differences, while 11 studies found improvements in glycaemic control . Improvements in physical activity or greater adherence to behavioural support were reported in all studies that had measured physical activity .…”

“…Management or frequency of symptoms was examined in 44 studies. Four of the studies that had investigated symptom frequency found no differences, and 25 studies reported reduction of symptoms and/or awareness of symptom triggers . Ten studies from interventions tailored to children and adolescents with asthma reported improved asthma control and decreased number of asthma exacerbations.…”

“…Knowledge was investigated in 10 studies . All these studies reported significant improvements in knowledge scores after intervention.…”

“…Of the studies dealing with patient education interventions, 14/17 studies resulted in beneficial effects as measured by one or several health economic outcomes . Three studies found no health economic impact or effects of the interventions .…”

Healthcare transition for adolescents and young adults with long‐term conditions: Qualitative study of patients, parents and healthcare professionals’ experiences

“…Current evidence suggests that well‐planned, effective transitional care can prevent deterioration in AYAs’ health and disengagement with health care; stable or improved disease control; improved knowledge, self‐management skills and patient satisfaction; improved relationships with healthcare professionals (HCPs) and parent satisfaction (Gabriel, McManus, Rogers, & White, ; Ladouceur et al, ; Mackie et al, ; Pyatak et al, ; van Staa, Sattoe, & Strating, ). In contrast, inadequate transition is associated with poor clinic attendance, loss to follow‐up; increased nonadherence to treatment, increased morbidities, lower physical well‐being, increased emergency/hospital admissions and adverse health outcomes (Garvey et al, ; Heery, Sheehan, While, & Coyne, ; Sheehan, While, & Coyne, ).…”