Structured Care Program May Ease Transition from Pediatric to Adult Care

A structured transition program can ease the change from pediatric to adult diabetes care, resulting in improvements in clinic attendance and satisfaction, as well as decreased emotional burden for the duration of intervention, according to a study presented at the American Diabetes Association’s 77th Scientific Sessions in San Diego.

Young adult patients with diabetes who move from receiving care in a pediatric setting to an adult setting can struggle with managing their diabetes and are susceptible to worsening glycemic control and its complications.

This multicenter, randomized trial in Canada enrolled 205 youth between the ages of 17 and 20 with type 1 diabetes who received care at diabetes clinics in academic or community settings. The study aimed to determine if a structured transition intervention program, and in particular access to a Transition Coordinator, would prove beneficial to young adults with type 1 diabetes during the transition of care from adolescence to adulthood.

The patients were randomly assigned to 2 groups—one with 104 patients in a structured transition care program, and one with 101 patients who received standard care, which did not include access to a Transition Coordinator. The transition program was designed to provide additional support to the youth and included a dedicated Transition Coordinator, who was a certified diabetes educator, to assist the patients in the transition process. The coordinator attended the patients’ clinic visits, and was accessible between visits by email, text or phone to problem solve specific diabetes care issues, and to coach the patients in navigating the health care system.

During the 18-month program, patients were seen in the pediatric care setting for 6 months, and then transferred to adult care, where they continued intervention or standard care for one year. Patients were given questionnaires to complete, and these questionnaires were completed by 71 (68.3%) of the patients in the structured transition program and by 57 (56.4%) of the patients in the standard care group.

Patients in the transition group reported they were more satisfied with care than patients in the standard care group (28.9% vs. 27.9%, P=0.04), and they reported less emotional burden of diabetes (2.3% vs. 2.7%, P=0.03).

“This is the first study to address the transition problem in a rigorous, scientific manner, and we were pleased to find improved clinic attendance rates and satisfaction with care during the intervention period. Although A1C levels were not statistically different between the two groups of patients, we were encouraged to see a trend for improved blood sugar control in the group with access to the Transition Coordinator, while the opposite was seen in the group who did not have this opportunity," lead study author Tamara Spaic, MD, MSc, assistant professor in the department of medicine, division of endocrinology and metabolism at the University of Western Ontario said in a press release about the study. "Transition coordinator support should become a standard of care for young adults with type 1 diabetes during the transition from pediatric to adult diabetes case since it improves continuity and satisfaction of care. A similar model could also be considered in other chronic childhood conditions, such as cystic fibrosis, congenital heart disease and inflammatory bowel disease.”

Reference

Spaic T, et al. A Structured transition program in young adults with type 1 diabetes is associated with improved satisfaction with diabetes care. Presented at: The American Diabetes Association’s 77th Scientific Sessions, June 9-13, 2017. San Diego.