Results of a specific and structured program for the transition of young patients with type 1 diabetes from the pediatric center to an adult hospital. The experience of a decade

Abstract

ObjectiveEvaluate the results of a healthcare and therapeutic education program (TEP) aimed at young patients with type 1 diabetes (T1D) transferred from a pediatric center. MethodologyThis was a prospective, pre-postest in young T1D patients transferred from 2005–2015. The program has four phases: coordinated transfer, evaluation and objective pacting, knowledge (DKQ2) adherence (SCI-R.es) and quality of life (DQoL and SF12). Results were compared according to Multiple Daily Injections (MDI) vs. Continuous Subcutaneous Insulin Infusión (CSII) and adherence (SCI-R.es <65 vs. >65%). ResultsA total of 330 patients were transferred (age 18.19±0.82 years, 49% females, glycated hemoglobin [HbA1c] 8.6±1.4%). The program was completed by 68%, and 61% did a group course. While no changes in HbA1c were observed at one year (8.3±1.4 vs. 8.2±1.4%), there were changes in severe hypoglycaemias/patient/year (0.23±0.64 to 0.05±0.34 p<0.001) and mild > 5 hypoglycaemias/patient/week (6.9% vs. 3.9% p=0.09). DQK2 knowledge increased (25.7±3.6 vs. 27.8±3.8 p<0.001), with no changes in quality of life or grade of adherence. Patients with CSII (n=21) performed more blood glucose controls and showed greater program adherence with no changes in metabolic control. Patients with the best initial adherence presented the best control (p<0.0001). A lower initial HbA1c and receiving the group course were associated with better clinical HbA1c results ≥0.5% (p<0.05). ConclusionsThe TEP improved some parameters of metabolic control without modifying the quality of life in young T1D patients. When comparing patients on MDI vs. CSII, there were no differences in metabolic control but there were when differences were evaluated considering treatment adherence.