Older teens with type 1 diabetes face challenges as they transition into adult care
As individuals with type 1 diabetes transition from their late teens into their 20s, they are faced with special challenges. Young adults with type 1 diabetes are at risk for gaps in medical followup, poor glycemic control, diabetes-related complications, and even early death. The transition from pediatric to adult diabetes providers can add further challenges, according to a new study.
The researchers mailed surveys to and received them back from 258 young adults with type 1 diabetes, with an average age of 19.5 years. Participants were asked about their living arrangements, education level, occupation, and coexisting medical conditions. Other questions asked about their reasons and preparation for transition to adult care, how satisfied they were with the process, and any gaps in care. From the medical record, the researchers collected data on age, sex, race, insurance, and most recent HbA1c level (a marker of blood-sugar control).
A third of patients reported gaps of more than 6 months between pediatric care and the establishment of adult diabetes care. The majority never had a transition preparation visit or received written transition materials. Patients less likely to report this gap had strong transition preparation as well as three or more pediatric diabetes visits in the year before their transition into adult care.
When asked about how prepared they felt to make the transition, only 63 percent reported feeling mostly or completely prepared. In addition, only 62 percent felt being mostly or completely satisfied with the process. Less than 15 percent reported receiving a transition preparation visit or being given written materials on it. In addition, less than half received a recommendation from an adult provider. While transition preparation decreased care gaps, it did not improve post-transition HbA1c levels. Pre-transition HbA1c predicted post-transition HbA1c, as did the patient's level of education.
The researchers point out that more robust transition preparation may be needed to ultimately improve young adult HbA1c. Interventions should be developed to improve the transition process and deliver developmentally tailored care as these young adults enter adult diabetes care. The study was supported in part by AHRQ (T32 HS00063).
See "Health care transition in patients with type 1 diabetes," by Katharine C. Garvey, M.D., M.P.H., Howard A. Wolpert, M.D., Erinn T. Rhodes, M.D., M.P.H., and others in the August 2012 Diabetes Care 35, pp. 1716-1722.