SEARCH highlights flaws in transfer from pediatric to adult diabetes care
medwireNews: US researchers call for tailored clinical programs and policies to improve the transition from pediatric to adult care, and thus prevent worsening glycemic control, in young adults with type 2 diabetes.
Using data from the SEARCH for Diabetes in Youth study, Shivani Agarwal (University of Pennsylvania, Philadelphia) and team found that just over half (56%) of 182 young adults (aged <18 years at baseline) with type 2 diabetes reported transfer to adult care at a follow-up SEARCH visit when they were aged 18–25 years.
A further 29% remained in pediatric care and 15% reported having no healthcare provider at follow-up.
Of note, 74% of participants in the no care group were uninsured, which was significantly higher than the 15% and 8% uninsured in the adult and pediatric care groups, respectively.
By contrast, the proportion of men and women, race/ethnicity, and parental education level did not differ significantly across the three care groups.
At follow-up, mean glycated hemoglobin (HbA1c) levels were significantly higher among those in adult care (9.0%) and no care (9.3%) compared with those in the pediatric care group (8.0%), despite there being no difference between the groups at baseline (7.1 and 7.2 vs 6.6%).
This meant a significantly higher proportion of patients in the adult care and no care groups had poor glycemic control (HbA1c ≥9.0%) at follow-up than in the pediatric care group, at 52.9% and 53.6% versus 26.9%.
On multivariable analysis, increasing age at diagnosis and diabetes duration at follow-up were both associated with a significantly increased likelihood for leaving pediatric care, at odds ratios of 1.8 and 1.4 per year, respectively.
And although the majority (75%) of participants were from racial or ethnic minorities, this was not associated with the likelihood for transfer from pediatric to adult care.
In addition, Agarwal and co-investigators found that transferring to adult care was associated with a significant 4.5-fold increased likelihood for poor glycemic control, while having no care provider at follow-up increased the likelihood 4.6-fold, when compared with remaining in pediatric care and after adjusting for baseline HbA1c, age at diagnosis, duration of diabetes, sex, and race/ethnicity.
“Although it is encouraging that the majority of young adults transferred to adult care by age 25 years, it is concerning that a large proportion experienced significantly worsened glycaemic control at follow-up,” the authors write in Diabetic Medicine.
They suggest: “Concerted efforts to train endocrinologists and primary care practitioners to incorporate developmentally appropriate approaches to young adult care, implementation of standardized clinical care pathways which bridge paediatric and adult medical systems, and recognition of the need for more ancillary support services, especially social work and psychosocial support, ultimately will be needed to curb this emergent problem.”
By Laura Cowen
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