Abstract
Abstract Objectives Adolescence is a challenging period for diabetes management, particularly when transitioning to adult care. There are reports highlighting concerns that transition to adult care may lead to poor glycemic control and clinic engagement. Our aim was to determine if a co-located pediatric and transition diabetes service would lead to better transition outcomes. Methods A retrospective medical records review was conducted on patients with type 1 diabetes attending a transition clinic in a metropolitan teaching hospital in Sydney, Australia. Patients referred from the hospital’s co-located pediatric diabetes clinic to the transition clinic were compared to those referred from external sources regarding important clinical outcomes such as glycosylated haemoglobin (HbA1c), clinic attendances, and complication rates between referral sources. Confounders such as age, gender, duration of diabetes and socioeconomic status were considered. Results Data was collected from 356 patients of which 121 patients were referred from the co-located pediatric diabetes clinic (IRG) and 235 patients from external sources (ERG). Improvements in HbA1c were only seen in the ERG at 6 and 12 months (p<0.001). Altogether 93% attended one or more medical appointments in the IRG compared to 83% in the ERG (p=0.03). There were more admissions for acute diabetes complications (17 vs. 8%, p=0.01) and more microvascular complications (20 vs. 9%, p<0.01) in the IRG vs. ERG group. Conclusions Although co-location of a pediatric and transition clinic improved medical engagement, this did not equate to better glycemic control or complication rates. Further research is warranted to determine what other strategies are required to optimise the transition process in diabetes care.
Highlights
Transition is a important life event for adolescents with chronic medical conditions as it involves transfer from pediatric to adult health care
Out of the ERG, 56 patients were referred from the local tertiary Children’s Hospital, 39 patients were self-referred, 37 patients were referred by their local general practitioner, 35 patients were referred from the inpatient ward and 26 patients from the emergency department of the same hospital, 25 patients were referred by private endocrinologists, and 17 patients were referred from other metropolitan hospitals
We described the outcomes of 356 adolescents (>16 years of age) and young adults with type 1 diabetes mellitus attending the diabetes transition clinic in a Western Sydney metropolitan hospital between 2008 and 2016
Summary
Transition is a important life event for adolescents with chronic medical conditions as it involves transfer from pediatric to adult health care. The transition coincides with the stage of life known as emerging adulthood (18–24 years). This age is often marked by geographic, economic and emotional separation from the parental home. Feelings of invulnerability and a tendency to reject adult control are often present. Ali et al.: Pediatric & transition clinic outcomes in diabetes this may further limit receptiveness to recommendations for diabetes management resulting in suboptimal diabetes care. There are studies that have expressed the transfer to adult care may be accompanied by poor glycemic control and decreased clinic attendances [1, 2]
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