Health Care Transition in Patients With Type 1 Diabetes
Young adult experiences and relationship to glycemic control
- Katharine C. Garvey, MD, MPH1⇓,
- Howard A. Wolpert, MD2,
- Erinn T. Rhodes, MD, MPH1,
- Lori M. Laffel, MD, MPH3,
- Ken Kleinman, PHD4,
- Margaret G. Beste, BA2,
- Joseph I. Wolfsdorf, MB, BCH1 and
- Jonathan A. Finkelstein, MD, MPH4,5
- 1Division of Endocrinology, Children’s Hospital Boston, Boston, Massachusetts
- 2Adult Section, Joslin Diabetes Center, Boston, Massachusetts
- 3Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Boston, Massachusetts
- 4Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
- 5Division of General Pediatrics, Children’s Hospital Boston, Boston, Massachusetts
- Corresponding author: Katharine C. Garvey, .
OBJECTIVE To examine characteristics of the transition from pediatric to adult care in emerging adults with type 1 diabetes and evaluate associations between transition characteristics and glycemic control.
RESEARCH DESIGN AND METHODS We developed and mailed a survey to evaluate the transition process in emerging adults with type 1 diabetes, aged 22 to 30 years, receiving adult diabetes care at a single center. Current A1C data were obtained from the medical record.
RESULTS The response rate was 53% (258 of 484 eligible). The mean transition age was 19.5 ± 2.9 years, and 34% reported a gap >6 months in establishing adult care. Common reasons for transition included feeling too old (44%), pediatric provider suggestion (41%), and college (33%). Less than half received an adult provider recommendation and <15% reported having a transition preparation visit or receiving written transition materials. The most recent A1C was 8.1 ± 1.3%. Respondents who felt mostly/completely prepared for transition had lower likelihood of a gap >6 months between pediatric and adult care (adjusted odds ratio 0.47 [95% CI 0.25–0.88]). In multivariate analysis, pretransition A1C (β = 0.49, P < 0.0001), current age (β = −0.07, P = 0.03), and education (β = −0.55, P = 0.01) significantly influenced current posttransition A1C. There was no independent association of transition preparation with posttransition A1C (β = −0.17, P = 0.28).
CONCLUSIONS Contemporary transition practices may help prevent gaps between pediatric and adult care but do not appear to promote improvements in A1C. More robust preparation strategies and handoffs between pediatric and adult care should be evaluated.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc11-2434/-/DC1.
- Received December 14, 2011.
- Accepted March 25, 2012.
- © 2012 by the American Diabetes Association.
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