SAT-268 Association between Transition Readiness and Diabetes Distress in Adolescents with Type 1 Diabetes Transitioning to Adult Care

Abstract

Introduction: The AM I ON TRAC questionnaire (also known as ON TRAC) is a 25-item survey that evaluates readiness for transition to adult care in adolescents with chronic conditions.1 This questionnaire is comprised of a knowledge scale (KS, 16 items) and a behavior cut-off score (BCS, 9 items). Adolescents with a score of ≥8 on the BCS are considered ready for transition to adult care. The validation study (n = 200) of the ON TRAC questionnaire included participants from pediatric diabetes, cardiology, gastroenterology, and neurology clinics, but there have been no studies on the use of the ON TRAC questionnaire in adolescents with type 1 diabetes (T1D) at the time of transition to adult care.1 The objective of this study was to determine which patient characteristics are associated with “readiness for transition” according to the ON TRAC BCS in this population. Methods: We obtained demographic information, clinical data, ON TRAC questionnaire scores, and T1D Diabetes Distress Scale scores (T1-DDS) from 100 adolescents with T1D recruited between 2016 and 2018 at their last pediatric clinic visit before transition to adult care. Transition readiness as defined by the BCS was analyzed as a dichotomous variable (i.e. ready for transition vs. not ready for transition). T1-DDS scores were summarized for each of the 7 diabetes distress subscales. We used univariable logistic regression to determine the factors associated with transition readiness. Results: 74% of study participants completed the ON TRAC questionnaire in its entirety, of which only 38% had a BCS that indicated readiness for transition. “Transition readiness” as indicated by the BCS was associated with lower T1-DDS management distress (OR 0.61, 95% CI 0.38-0.96, p = 0.034). “Transition readiness” was also associated with lower diabetes distress on the T1-DDS 5-item screen (OR 0.48, 95% CI 0.25-0.93, p = 0.029), which uses 5 questions from different subscales of the T1-DDS. These results suggest that those who are “ready for transition” have lower levels of diabetes distress. Transition readiness as defined by the BCS score was not associated with any other demographic or clinical parameter. Conclusions: Our results show that levels of diabetes distress may be able to predict transition readiness (and vice versa). Despite numerous recommendations from international consortiums on the best practices for the pediatric-to-adult transition in T1D care, there are few well-accepted tools to inform clinicians, patients, and families of transition readiness.2-3 This study demonstrates that the ON TRAC questionnaire may be an appropriate tool to assess transition readiness in youth with T1D and that diabetes distress is associated with transition readiness.