PDB72 Challenges and Barriers during Transition of Type 1 Diabetic Patients from Pediatric into Adult Care in Armenia

Abstract

Recent years a number of interventions are developed and implemented in some couintries to support young patients’ transition into adult clinics. There is no any transition clinic for type 1 diabetes in Armenia to provide smooth and adequate transition of diabetics from pediatric into adult care. The transition is provided automatically after the patients get 18 years old. In this regard we have prepared a questionnaire for patients to reveal the difficulties and disadvantages of this mandatory transition in health care structure of Armenia. 48 type 1 diabetic young patients, aged >18years old, were asked to fill in the questionnaire about their transition from pediatric to adult care. Their pediatric data of last mean HbA1c before transition was recorded from the pediatric endocrinology clinic and compared with current mean HbA1c (after transition). Statistical analyses were performed to determine the significance of findings. In all cases null hypothesis was rejected if p<0.05. Male/female ratio of respondents was as 26/22, and the mean age was 24±1.2. 93.75% of respondents mentioned measurement of HbA1c once a year after transition versus 3-4 times per year in pediatric clinic(p<0.05). Mean HbA1c was 11.3±0.45 versus the mean HbA1c before their transition 9.82±0.36(p<0.05). Respondents mentioned emotional and psychosocial barriers of transition: 87.5%(N=42)-less trust to adult care provider, and 37.5%(N=18)-low self-responsibility. As a major challenge 39.6%(N=19) patients mentioned low expertise of adult care providers, and 22.9%(N=11)-low financial support in adult health care system. Interestingly, 93.75%(N=45) of respondents highlighted the need of transition care coordinator between pediatric and adult providers. Current work highlights the need of a transition clinic (coordinating unit) for transferring of type 1 diabetics from pediatric into adult care in Armenia, aiming to a better engagement of both pediatric and adult care providers, and to improve the diabetes control and psychosocial environment of young diabetic patients.