Transition coordinators may improve shift from pediatric to adult diabetes care
medwireNews: Young adults with diabetes type 1 show improvements in clinic attendance rates when a nonmedical transition coordinator is present during the changeover from pediatric to adult diabetes care, say the authors of a Canadian clinical trial.
This open-label, non-randomized study included young adults, aged 17–18 years, with type 1 diabetes transitioning from pediatric to adult diabetes care who were allocated to receive support from a transition coordinator (n=101) or usual care (n=102).
“This intervention used a non-medical transition coordinator with simple, readily accessible communication technologies, thus increasing the sustainability of this strategy,” writes the team in Diabetologia.
Sonia Butalia (University of Calgary, Alberta, Canada) and fellow researchers report that 11.9% of individuals in the intervention group did not attend any adult outpatient diabetes appointments in the year after transition, compared with 47.1% in the control group. After 18 months, this number decreased to 9.9% in the intervention group but remained the same in the control group.
In a multivariate logistic regression analysis, participants in the control group were significantly more likely to not attend follow-up in the year following transfer, at an odds ratio of 4.9.
The mean number of follow-up visits with any healthcare professional in the year following the transfer was also higher in the intervention group than in the usual care group (5.8 vs 3.0) and this was consistent after 18 months (6.0 vs 3.0).
There were no between-group differences in mean glycated hemoglobin (HbA1c) levels at 12 and 18 months, but after a year, the number of individuals with “abnormally” high mean HbA1c values (>75 mmol/mol [9.0%]) was significantly lower in the intervention group than in the control group (24.8 vs 41.1%). This trend remained consistent after 18 months (25.7 vs 42.2%).
Similar rates of emergency department visits and hospitalization were observed in both groups, and these occurred at a low rate during follow-up at 12 and 18 months, say the researchers.
“We are encouraged by our findings but know that other strategies that minimise adverse health events and improve quality of care for youth with diabetes and their families through this phase of their lives are necessary,” conclude Butalia and fellow investigators.
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