Transition Programs Beneficial for Youth with Diabetes Moving to Adult Care

Transitioning from adolescence to adulthood can be especially difficult for patients with type 1 diabetes. Adolescences and young adults with type 1 diabetes may benefit from a structured transition program when care shifts from pediatric to adult care, according to a study presented at the American Diabetes Association’s 77th Scientific Sessions.

Successful diabetes management requires significant patient involvement, since lifelong care is crucial for preventing complications. Moving from pediatric to adult care can result in patients developing problems managing their condition and can be susceptible to poor glycemic control and related complications.

The investigators aimed to determine if a structured transition intervention program would be beneficial for this population.

Included in the new study were 205 patients aged 17 to 20 who had type 1 diabetes. All patients received care at diabetes clinics. Patients were randomized to be placed in a structured transition care program or receive standard care.

The structured transition program was created to provide support to patients and included a transition coordinator, who is a diabetes educator that can assist patients. The transition coordinator went to the clinic visits, was accessible between visits to discuss diabetes-related issues, and showed patients how to navigate the healthcare system, according to the session.

For 6 months, patients were still treated in pediatrics and were then transferred to adult care for 1 year. Patients filled out the Client Satisfaction Questionnaire, the Diabetes Quality of Life questionnaire, and the Diabetes Distress Scale at baseline and the conclusion of the study.

The investigators received questionnaire responses for 68.3% of patients in the structured transition program and 56.4% of patients receiving standard care.

Patients in the transition care program reported they had contact with the transition coordinator an average of 17.6 times during the 18 months. These patients attended 4.1 clinic visits, while the standard care group only attended an average of 3.6 visits, according to the session.

Patients in the transition program also reported satisfaction with the care received and had less emotional burden of diabetes compared with the standard care group.

These results suggest that patients included in the transition care programs received better care compared with standard care patients.

“Transition of care is a high-risk period associated with significant health care gaps, missed intervention opportunities and worse health outcomes,” said lead study author Tamara Spaic, MD, MSc. “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.”

The authors plan to conduct a 1-year follow-up and an economic analysis to further determine whether this intervention is successful in the long-term, according to the session.

“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,” Dr Spaic said. “A similar model could also be considered in other chronic childhood conditions, such as cystic fibrosis, congenital heart disease and inflammatory bowel disease.”