medwireNews: Structured transition support improves clinic attendance, satisfaction with care, and diabetes-related distress in people with type 1 diabetes moving from pediatric to adult care, but only for the duration of the program, Canadian research shows.
“Sustaining these improvements requires sensitization of adult health care providers to invest in prolonged support for young adults beyond the first 2 years posttransition, which will continue to provide benefits throughout their life span,” Tamara Spaic (St. Joseph’s Health Care London, Ontario) and co-investigators remark.
The multicenter study included 205 young adults (aged 17–20 years) with type 1 diabetes who were randomly assigned to receive an 18-month transition program with a transition coordinator (n=104) or to receive standard care (n=101).
The intervention included three pediatric clinic visits in the first 6 months followed by three adult visits in the remaining 12 months, with the transition coordinator present at each. There were also two clinic visits in the 12-month follow-up period. Individuals assigned to standard care followed the same clinic schedule without the additional support from the transition coordinator.
During the transition period, the mean number of clinic visits was significantly higher among people in the transition program compared with those receiving standard care, at 4.1 versus 3.6, and a significantly higher proportion in the intervention group attended all six visits, at 49% versus 26%.
Individuals receiving additional transitional support also reported greater satisfaction with care (Client Satisfaction Questionnaire mean score 29.0 vs 27.9) and less diabetes-related distress (Diabetes Distress Scale mean score 2.0 vs. 2.2) during the intervention than those receiving standard care.
However, there was no difference between the groups in the mean change in glycated hemoglobin (HbA1c) from baseline to 18 months (adjusted difference 0.04% [0.40 mmol/mol]).
Furthermore, during the 12-month follow-up period, there was no significant difference in the primary study outcome of the proportion of patients failing to attend at least one clinic visit, at 51% in the intervention group and 54% in the routine care group.
The mean number of clinic visits during follow-up was 1.3 in both groups, and at the end of the follow-up period there was still no difference between the groups in the level of care satisfaction or diabetes distress.
The researchers also note that during the follow-up period HbA1c tended to be lower among the individuals who received the intervention relative to those who did not, at 8.3% versus 8.8% (68 vs 73 mmol/mol), and they speculate that “longer follow-up and/ or a larger sample size would support the hypothesis that routine clinic visits result in better glycemic control and improved long-term diabetes-related outcomes.”
Writing in Diabetes Care, Spaic et al add that the drop-out rate was “lower than anticipated,” at 20% in both groups, and this “may have affected the ability to detect a difference between the groups at completion of the trial.”
By Laura Cowen
medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group
Diabetes Care 2019; doi:10.2337/dc18-2187
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