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J Adolesc Health. 2017 Feb;60(2):212-218. doi: 10.1016/j.jadohealth.2016.09.004. Epub 2016 Nov 23.

Clinical and Psychosocial Outcomes of a Structured Transition Program Among Young Adults With Type 1 Diabetes.

Author information

1
Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California. Electronic address: beth.pyatak@chan.usc.edu.
2
Department of Pediatrics, University of Southern California, Los Angeles, California.
3
Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California.
4
Department of Pediatrics, University of Southern California, Los Angeles, California; Children's Hospital of Los Angeles, Los Angeles, California.
5
Keck School of Medicine, University of Southern California, Los Angeles, California.

Abstract

PURPOSE:

We identified and treated young adults with type 1 diabetes who had been lost to follow-up during their transfer from pediatric to adult care, comparing their clinical, psychosocial, and health care utilization outcomes to participants receiving continuous care (CC) throughout the transition to adult care.

METHODS:

Individuals in their last year of pediatric care (CC group, n = 51) and individuals lost to follow-up in the transfer to adult care ("lapsed care" [LC] group, n = 24) were followed prospectively for 12 months. All participants were provided developmentally tailored diabetes education, case management, and clinical care through a structured transition program.

RESULTS:

At baseline, LC participants reported lapses in care of 11.6 months. Compared with CC participants, they had higher hemoglobin A1C (A1C; p = .005), depressive symptoms (p = .05), incidence of severe hypoglycemia (p = .005), and emergency department visits (p = .004). At 12-month follow-up, CC and LC participants did not differ on the number of diabetes care visits (p = .23), severe hypoglycemia (no events), or emergency department visits (p = .22). Both groups' A1C improved during the study period (CC: p = .03; LC: p = .02). LC participants' depressive symptoms remained elevated (p = .10), and they reported a decline in life satisfaction (p = .007). There was greater loss to follow-up in the LC group (p = .04).

CONCLUSIONS:

Our study suggests that, for young adults with a history of lapses in care, a structured transition program is effective in lowering A1C, reducing severe hypoglycemia and emergency department utilization, and improving uptake of routine diabetes care. Loss to follow-up and psychosocial concerns remain significant challenges in this population.

KEYWORDS:

Continuity of patient care; Diabetes mellitus; Transition to adult care; Type 1

PMID:
27889401
PMCID:
PMC5253301
DOI:
10.1016/j.jadohealth.2016.09.004
[Indexed for MEDLINE]
Free PMC Article

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