Diabetes educators, CGM shorten gap between pediatric and adult care in type 1 diabetes
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Transitioning from pediatric to adult diabetes care is associated with a prolonged gap in care for teens and young adults who do not see a diabetes educator or use a continuous glucose monitor, according to a speaker.
“Adolescents and young adults with type 1 diabetes transitioning from pediatric to adult care have poor glycemic control and health outcomes,” Diana Soliman, MD, a second-year endocrinology fellow at Duke University, told Healio. “In this study, we looked at what factors are associated with the gap in care.”
Researchers conducted a retrospective longitudinal study with 214 adolescents and young adults with type 1 diabetes (54.8% female; 73.4% white) who had at least two pediatric endocrinology visits and one adult endocrinology visit within 3 years of their previous pediatric visit at Duke University Health System. Data on comorbidities, health care utilization, CGM and insulin pump use were obtained through electronic health records. The findings were presented at the AACE Annual Scientific and Clinical Conference.
The study cohort had a mean HbA1c of 9.4% and took a median 7.9 months to transition from pediatric to adult care. After adjusting for sociodemographic and clinical factors, participants had a longer gap in care if they had not been seen by a diabetes educator (relative effect = 1.68; 95% CI, 1.06-2.67; P = .03) or used CGM (relative effect = 1.86; 95% CI, 1.24-2.79; P < .01) before transitioning to adult care. HbA1c, insulin pump use, comorbidities, ED visits and hospitalizations were not associated with gap in care.
Soliman noted the study’s findings were limited because they included only people who transitioned to adult care at Duke University Health System. There were 1,615 people who had at least two pediatric endocrine visits at Duke University Health System, but only 214 who also had an adult visit within the health system were included in the study. Because the study was retrospective, it is unknown how many of the 1,401 people excluded from the analysis visited an adult endocrinologist outside of Duke.
“Further research is needed to understand which patients are lost to follow-up,” Soliman said. “We need to understand what implications a prolonged gap in care has on clinical outcomes and design interventions to improve outcomes for this vulnerable patient population.”
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Soliman D. Transition from pediatric to adult care in type 1 diabetes mellitus: A longitudinal analysis of clinical characteristics and outcomes. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; May 26-29, 2021 (virtual meeting).
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