Transition to adult diabetes care in Germany-High risk for acute complications and declining metabolic control during the transition phase

Kapellen, T; Müther, Silvia; Schwandt, Anke; Grulich-Henn, Juergen; Schenk, Bernd; Schwab, KO; Marg, W.; Holl, Reinhard W.

doi:10.1111/pedi.12687

Cited by 43 publications

(28 citation statements)

References 15 publications

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“…In adults, the median HbA 1c testing frequency was 8 (5; 9) times per 2 years, with 64% of the individuals being categorized as undergoing 'frequent' HbA 1c testing (at least seven HbA 1c measurements per 2 years) [16]. Transition from paediatric to adult care is a crucial time, however, and is often associated with deterioration of metabolic control [17][18][19]. In a T1DX survey of young adults aged 18 to <30 years who had already transitioned to adult care, 21% of the respondents reported a gap of >6 months between paediatric and adult diabetes care [17].…”

Section: Discussionmentioning

confidence: 99%

“…In a T1DX survey of young adults aged 18 to <30 years who had already transitioned to adult care, 21% of the respondents reported a gap of >6 months between paediatric and adult diabetes care [17]. A DPV study even indicated that 60% of individuals with type 1 diabetes transitioning from paediatric to adult care had a period of >1 year between the last paediatric care visit and the first adult care visit [18].…”

Section: Discussionmentioning

confidence: 99%

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The Transatlantic HbA_1c gap: differences in glycaemic control across the lifespan between people included in the US T1D Exchange Registry and those included in the German/Austrian DPV registry

et al. 2019

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Aim To compare HbA 1c levels across the lifespan in people with type 1 diabetes in the USA with those in Germany/ Austria, and to examine potential differences in HbA 1c levels between sexes, insulin delivery methods and minority status.Methods Data were extracted from the US T1D Exchange Registry (n=18 381 participants from 73 sites) and from the German/Austrian Prospective Diabetes Follow-up Registry, the DPV (n=32 643 participants from 362 sites). Mean HbA 1c was calculated for each year of age for individuals aged ≤25 years, and at 2-year age intervals for individuals aged >25 years. Curves for mean HbA 1c by age were estimated using locally weighted scatterplot smoothing. HbA 1c differences between registries, sexes, insulin delivery methods, and minority status were assessed by age group using multiple linear regression. ResultsIn both registries, mean HbA 1c increased by~11 mmol/mol (1.0%) between the ages of 9 and 18 years, although at quite different absolute levels: from 66 mmol/mol (8.2%) to 77 mmol/mol (9.2%) in the T1D Exchange Registry, and from 56 mmol/mol (7.3%) to 66 mmol/mol (8.2%) in the DPV. Sex differences were observed in the DPV only. In the T1D Exchange Registry, injection users had higher mean HbA 1c than pump users across the lifespan, whereas in the DPV higher HbA 1c levels in injection users were observed in the age groups 6 to <12 years, 12 to <18 years, and 30 to <50 years (P < 0.001). Minority status was significantly associated with higher HbA 1c in most age groups in both registries. Conclusions Significant differences in HbA 1c were noted between the USA and Germany/Austria, with disparities more pronounced in early childhood through to young adulthood. Further studies should identify causes for these disparities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Transatlantic HbA_1c gap: differences in glycaemic control across the lifespan between people included in the US T1D Exchange Registry and those included in the German/Austrian DPV registry

et al. 2019

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“…Individuell unterschiedlich terminiert steht dann die Transition von der pädiatrischen Diabetologie in die Erwachsenen-Diabetologie an. Oftmals ist in dieser Zeit der Verantwortungsverschiebung eine Reduktion der Therapieadhärenz und Sorgfalt mit weniger Glukosemessungen und einem Anstieg des HbA 1c -Werts zu beobachten [5].…”

Section: Introductionunclassified

Psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen mit Typ-1-Diabetes

Geirhos

Domhardt

Galler

et al. 2020

Diabetologie und Stoffwechsel

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ZusammenfassungJugendliche und junge Erwachsene mit Typ-1-Diabetes sind häufig von komorbiden psychischen Störungen betroffen. Dabei zeigt die Studienlage zur Verbreitung ein heterogenes und inkonsistentes Bild. Diagnose und Behandlung der somatopsychischen Begleiterkrankungen beeinflussen den Behandlungs- und Krankheitsverlauf sowie die Lebensqualität der Betroffenen. Trotzdem wird dies in der klinischen Praxis selten frühzeitig berücksichtigt. Das multizentrische Verbundprojekt COACH verfolgt das Ziel, die Erkennung und Behandlung psychischer Komorbidität für diese Zielgruppe in der bundesweiten Routineversorgung zu optimieren.

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“…The transfer from pediatric care to adult care carries a considerable health risk for youth with special health care needs (YSHCN [1][2][3]. This phase is associated with missed medical appointments [4,5], poor health outcomes [6] and lower overall quality of life [7,8]. Recommendations include structural changes in health care systems [9][10][11] as well as propositions on how to support patients while transferring [12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Be on TRAQ – Cross-cultural adaptation of the Transition Readiness Assessment Questionnaire (TRAQ 5.0) and pilot testing of the German Version (TRAQ-GV-15)

Culen

Herle

König

et al. 2019

Journal of Transition Medicine

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ObjectiveTransfer from pediatric care into the adult health care system is known to be a vulnerable phase in the lives of youth with special health care needs (YSHCN). Recommendations from the literature favor assessment of transition readiness rather than simply pass over YSHCN from pediatric to adult-centered care by the age of 18. Nevertheless, no validated and disease neutral assessment instrument in German exists to date. Hence, our aim was to cross-culturally adapt and to pilot-test a German version of the Transition Readiness Assessment Questionnaire (TRAQ 5.0). We wanted to provide a tool that can be applied broadly during the health care transition (HCT) process of YSHCN.MethodsThe development included translating and adapting TRAQ 5.0 to German and conducting a pilot-study with 172 YSHCN between the ages of 14 and 23.ResultsCross-cultural adaptation resulted in the TRAQ-GV-15. Exploratory factor analysis led to a 3 factor-structure. Internal consistency for the overall score was good with a Cronbach’s alpha of 0.82. Age, in contrast to sex, had a significant effect on the TRAQ scoring. The administration of the TRAQ-GV-15 was well received and demonstrated good feasibility.ConclusionThe TRAQ-GV-15 is an easily applicable and clinically usable instrument for assessing transition readiness in German speaking YSHCN prior to HCT.

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Transition to adult diabetes care in Germany-High risk for acute complications and declining metabolic control during the transition phase

Abstract: This phase of life bears a high risk for detrimental outcome in young adults with T1D. Structured transition programs with case management are therefore needed to improve the transition process and outcomes.

Cited by 43 publications

References 15 publications

The Transatlantic HbA_1c gap: differences in glycaemic control across the lifespan between people included in the US T1D Exchange Registry and those included in the German/Austrian DPV registry

The Transatlantic HbA_1c gap: differences in glycaemic control across the lifespan between people included in the US T1D Exchange Registry and those included in the German/Austrian DPV registry

Psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen mit Typ-1-Diabetes

Be on TRAQ – Cross-cultural adaptation of the Transition Readiness Assessment Questionnaire (TRAQ 5.0) and pilot testing of the German Version (TRAQ-GV-15)

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Transition to adult diabetes care in Germany-High risk for acute complications and declining metabolic control during the transition phase

Abstract: This phase of life bears a high risk for detrimental outcome in young adults with T1D. Structured transition programs with case management are therefore needed to improve the transition process and outcomes.

Cited by 43 publications

References 15 publications

The Transatlantic HbA1c gap: differences in glycaemic control across the lifespan between people included in the US T1D Exchange Registry and those included in the German/Austrian DPV registry

The Transatlantic HbA1c gap: differences in glycaemic control across the lifespan between people included in the US T1D Exchange Registry and those included in the German/Austrian DPV registry

Psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen mit Typ-1-Diabetes

Be on TRAQ – Cross-cultural adaptation of the Transition Readiness Assessment Questionnaire (TRAQ 5.0) and pilot testing of the German Version (TRAQ-GV-15)

Contact Info

Product

Resources

About

The Transatlantic HbA_1c gap: differences in glycaemic control across the lifespan between people included in the US T1D Exchange Registry and those included in the German/Austrian DPV registry

The Transatlantic HbA_1c gap: differences in glycaemic control across the lifespan between people included in the US T1D Exchange Registry and those included in the German/Austrian DPV registry