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Mental health, parental divorce linked to less glycemic control after transfer to adult care
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Danish adolescents and young adults with type 1 diabetes saw an improvement in HbA1c after the transfer from pediatric to adult care, but patients with a mental health condition or divorced parents were more likely to experience poorer glycemic control and self-care, according to findings from a retrospective study.
“Young people with a chronic disease are particularly challenged when multiple changes during this period of life conflict with disease management,” Pernille Castensøe-Seidenfaden, a PhD student in the pediatric and adolescent department at Nordsjaellands Hospital in Hillerød, Denmark, and colleagues wrote. “For young people with type 1 diabetes, this affects daily diabetes routines, such as measuring blood glucose, taking insulin and counting carbohydrates, resulting in poor glycemic control, increased hospitalization rates, loss to follow-up, early onset of long-term complications and increased mortality. The transfer of medical care from pediatric to adult settings is a particularly challenging period for young people with type 1 diabetes as they engage with new health care providers and are expected to assume more self-care responsibilities.”
Researchers analyzed data from 126 patients with type 2 diabetes aged 14 to 22 years from 2 years before until 2 years after the period of transfer to adult care (52% male; median age at transfer of care, 18 years). Patients were followed during pediatric care at Nordsjaellands Hospital before transfer, and then at either a hospital-affiliated adult diabetes clinic or the Steno Diabetes Center in Denmark. Researchers used medical records to assess changes in glycemic control and associations between acute hospital admissions, low visit attendance rates, loss to follow-up and baseline HbA1c level.
Within the cohort, mean HbA1c before transfer to an adult care clinic was 9.4%; each year after transfer, HbA1c decreased by a mean of 0.3% (P = .005). Patients with a learning disability and/or mental health condition had an HbA1c that was on average 0.7% higher than patients without a mental health condition (95% CI, –0.3 to 1.6), but these patients also experienced a faster decrease in HbA1c after transfer to adult care, according to the researchers.
Patients with divorced parents also had mean HbA1c levels that were 1.2% higher in both pediatric and adult care (95% CI, 0.6-1.9), a level that persisted after adjustment for changes in time in mean HbA1c (P = .032).
During the 4-year study period, 27% of patients had at least one acute diabetes-related hospital admission, and 45% did not attend two or more clinic visits. The median gap between pediatric and adult care was 76 days; 11 patients (9%) had a gap of at least 6 months.
Nearly one-third of participants were admitted to the hospital for acute diabetes care. Researchers found that loss to follow-up (P < .001), low visit attendance (P < .011), higher baseline HbA1c (P < .006), and having a mental health condition (P < .005) or divorced parents (P < .027) were associated with acute diabetes-related hospital admissions.
“Our findings underscore a general need to pay special attention to supporting young people in their self-management of diabetes, especially those whose parents are divorced, those with a learning disability and/or mental health condition and who frequently skip clinic visits,” the researchers wrote. “Future studies should seek to better understand the challenges faced by young people with type 1 diabetes and their parents and to develop interventions to support young people in the transition from childhood to adulthood.” – by Regina Schaffer
Disclosure: The Rosalie Petersen Foundation and Fru Olga Bryde Nielsen Foundation in Denmark funded this study. The researchers report no relevant financial disclosures.
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