Health Care Transition in Patients With Type 1 Diabetes

Abstract

OBJECTIVETo examine characteristics of the transition from pediatric to adult care in emerging adults with type 1 diabetes and evaluate associations between transition characteristics and glycemic control.RESEARCH DESIGN AND METHODSWe developed and mailed a survey to evaluate the transition process in emerging adults with type 1 diabetes, aged 22 to 30 years, receiving adult diabetes care at a single center. Current A1C data were obtained from the medical record.RESULTSThe response rate was 53% (258 of 484 eligible). The mean transition age was 19.5 ± 2.9 years, and 34% reported a gap >6 months in establishing adult care. Common reasons for transition included feeling too old (44%), pediatric provider suggestion (41%), and college (33%). Less than half received an adult provider recommendation and <15% reported having a transition preparation visit or receiving written transition materials. The most recent A1C was 8.1 ± 1.3%. Respondents who felt mostly/completely prepared for transition had lower likelihood of a gap >6 months between pediatric and adult care (adjusted odds ratio 0.47 [95% CI 0.25–0.88]). In multivariate analysis, pretransition A1C (β = 0.49, P < 0.0001), current age (β = −0.07, P = 0.03), and education (β = −0.55, P = 0.01) significantly influenced current posttransition A1C. There was no independent association of transition preparation with posttransition A1C (β = −0.17, P = 0.28).CONCLUSIONSContemporary transition practices may help prevent gaps between pediatric and adult care but do not appear to promote improvements in A1C. More robust preparation strategies and handoffs between pediatric and adult care should be evaluated.

Transitioning from Pediatric to Adult Diabetes Care

“…Providers reported a patient's level of maturity as the primary basis for transition and felt mastery of self-care behaviors was the most significant factor during the diabetes transition. This inclination is supported by Garvey and colleagues [5] who found individual patients' self-care proficiency more relevant to health outcomes than chronological age at the time of transition [5]. In our study, providers and patients agreed that learning how to manage insurance policies and the financial costs of diabetes in order to independently maintain self-care were the greatest challenges.…”

“…Unfortunately, studies report significant gaps in follow-up care and a decrease in physician visits after transferring from pediatric to adult care [4]. For instance, one study found 34% of patients reported a gap > 6 months between pediatric and adult diabetes care, resulting in greater risk for loss to follow-up care [5]. Other studies confirm a notable decrease in physician visits after transitioning to adult care and also report that fewer physician visits were associated with poor glycemic control [6,7].…”

“…Varying systems include transfer to an adult clinic or different hospital, transition to a combination of pediatric and adult care providers, and transfer to a young adult clinic within the same pediatric hospital [4]. Likewise, there is a wide-degree of variation in preparing patients for transitioning from pediatric to adult care with some patients receiving no information, some receiving specific adult provider or clinic recommendations, some having a specific visit to discuss transition, and others being prepared for adult diabetes care by having a pediatric diabetes visit without a parent/guardian in the room and discussing independent diabetes self-management with the pediatric provider [5]. In 2011, the American Diabetes Association (ADA) released recommendations for transition from pediatric to adult diabetes care systems, including preparing adolescents through a gradual shift to self-management (e.g.…”

Evaluating Continuity During Transfer to Adult Care: A Systematic Review

“…Two articles reported results from the same study. 18,19 No additional articles were retrieved from searches of the reference lists of these 24 articles.…”

Using Photo-Elicitation to Explore Young Adult Perspectives on Coping with Type 1 Diabetes

“…The goal of self-management is to maintain normalized blood glucose levels and avoid complications. Advances in technology and treatment options have significantly improved the longevity and health outcomes for people with T1D, yet despite advances in treatment and technology, young adults with diabetes are at risk for serious health threats such as microvascular complications, anxiety, depression, and gaps in clinical care [2,3]. The psychological impacts of diabetes resulting in depression, anxiety, and distress can negatively affect self-management and quality of life, especially for young people [4].…”