Diabetes care gaps at key age increase risk for complications
medwireNews: Almost half of young adults with type 1 diabetes do not see a diabetes physician for more than a year during their transition from pediatric to adult care, and this lack of contact is associated with an increased risk for complications, Canadian research shows.
Rayzel Shulman (University of Toronto, Ontario) and co-investigators suggest that “integration of primary care into transition processes for those who access care may be effective” in increasing contact and reducing complications, but they add that “further work is needed to determine the optimal way to [do this].”
The study included 2525 individuals aged 17 years and older who were diagnosed with diabetes before the age of 15 years, 47.0% of whom had a gap in diabetes care of more than 12 months during transition age (17–18 years). The mean time from the final visit with the pre-transition diabetes physician to the first visit with the eventual adult diabetes physician was 8.9 months.
During early adulthood (19–26 years), 446 individuals (17.7%) had at least one admission for ketoacidosis and six patients died.
The researchers found that the risk for ketoacidosis or death was a significant 31% higher among the patients who had a gap in diabetes care of more than 12 months, compared with a gap of less than 6 months.
“This suggests that a prompt connection with the eventual adult diabetes physician might prevent adverse events in early adulthood,” Shulman et al write in Diabetic Medicine.
Patients more likely to have longer gap in diabetes care during transition included those from the highest deprivation quintile, those living in rural areas, and those with a diabetes-related admission for ketoacidosis, hypoglycemia, or hyperglycemia between the ages of 15 and 19 years.
The team also found that 9.5% of study participants had no visits with a primary care physician during transition age, which was associated with a 42% increased risk for ketoacidosis or death.
They expected to see a reduced risk for these complications among individuals who kept the same primary care provider through transition. But this was not the case; a visit with any primary care physician versus none was protective against the risk for ketoacidosis or death.
Similarly, a visit with the eventual adult diabetes physician during transition age was not associated with a decreased risk for ketoacidosis or death.
Shulman and co-authors conclude that the gaps in care that they have identified “may be missed opportunities for preventing acute diabetes complications during this vulnerable time.”
By Laura Cowen
medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group