This article is more than 5 years old. Information may no longer be current.
Youth require additional support in transition to adult diabetes care
Click Here to Manage Email Alerts
It is established within the literature that youth with type 1 diabetes have a greater risk for developing poor glycemic control as they enter adulthood. However, new data suggest patients diagnosed with diabetes during adolescence require more support than originally thought when transferring to adult diabetes care.
Debra S. Lotstein, MD, MPH, of the department of pediatrics at the David Geffen School of Medicine at UCLA, and colleagues examined 185 adolescent patients with recently diagnosed type 1 diabetes in the SEARCH for Diabetes in Youth Study (aged 18 years at follow-up).
According to data, 57% of the patients had transitioned to adult diabetes care providers by follow-up (4.5 years after baseline visit).
Researchers wrote that the average HbA1c was 7.5% at baseline and 9.2% at the follow-up visit. The estimated median age at transition of care was 20.1 years (95% CI, 19.8-20.4). They wrote that older age, lower baseline HbA1c and less parental education were linked to increased odds for transition to adult care.
Data indicate the odds for poor glycemic control at the time of follow-up were 2.5 times greater among patients who transitioned into adult care compared with those who remained in pediatric care, researchers wrote.
“Further studies are needed to understand the factors mediating the relationship between changing provider and diabetes disease outcomes, as well as the type and duration of assistance needed to eliminate the transition-related deterioration in glycemic control,” Lotstein and colleagues wrote.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to Top
Korey K. Hood, PhD
In this article, Lotstein and colleagues from the SEARCH for Diabetes in Youth Study tackle a significant issue in type 1 diabetes; the transition from pediatric to adult care. As the authors note, major organizations including the American Diabetes Association offer guidelines for transitioning youth with type 1 diabetes to adult care, yet there is little uniformity in practice. In this sample of 185 youth, representing one of the largest long-term studies on transition, the majority of youth had transitioned by the age of 20. Unfortunately, those who had transitioned from pediatric to adult care were two and a half times more likely than those still in pediatric care to demonstrate poor glycemic control. Further, certain youth – those identified as non-white or of Hispanic ethnicity – were at elevated risk of poor glycemic control at follow-up. The authors’ assertion that we need to pay more attention to the whole person, sociocultural characteristics, and factors such as psychosocial functioning during transition to adult care is absolutely supported by the evidence base. In particular, data showing the critical importance of behavioral and emotional health for people with diabetes support and emphasize this point. In addition to attempting to replicate “pediatric” attention and support in adult diabetes care clinics as the authors suggest, it may be equally important to consider continued diabetes care from the pediatric multidisciplinary care team and stagger small transfers and transitions well in to the mid-20s. Whatever the best solution is, this article and countless others highlight that we still have much work left to do to optimize outcomes for these young women and men with type 1 diabetes.
Click Here to Manage Email Alerts