Transition coordinators could enhance shift from pediatric to grownup diabetes care


medwireNews: Young adults with type 1 diabetes show improvement in clinic attendance rates when a non-medical transition coordinator is present during the transition from pediatric to adult diabetes care, say authors of a Canadian clinical study.

This open-label, non-randomized study enrolled young adults aged 17 to 18 with type 1 diabetes who transitioned from pediatric to adult diabetes care and received support from a transition coordinator (n = 101) or standard care (s) = 102).

“This intervention employed a non-medical transition coordinator with simple, easily accessible communication technologies, which made this strategy more sustainable,” the team writes in Diabetologia.

Sonia Butalia (University of Calgary, Alberta, Canada) and colleagues report that 11.9% of people in the intervention group did not attend outpatient adult diabetes testing appointments in the year after transition, compared with 47.1% in the control group. After 18 months this number decreased to 9.9% in the intervention group, but remained the same in the control group.

In a multivariate logistic regression analysis, the probability that participants in the control group did not participate in the follow-up examination in the year after the transfer was significantly higher with a rate of 4.9.

The mean number of follow-up visits with a healthcare professional in the year after the transfer was also higher in the intervention group than in the usual care group (5.8 versus 3.0) and was consistent at 18 months (6.0 versus 3.0).

There were no inter-group differences in mean glycated hemoglobin (HbA1c) levels at 12 and 18 months, but after one year the number of people with “abnormally” high mean HbA1c (> 75 mmol / mol) [9.0%]) was significantly lower in the intervention group than in the control group (24.8 vs. 41.1%). This trend remained constant after 18 months (25.7 versus 42.2%).

Similar rates of emergency room visits and hospital stays were observed in both groups, and these occurred at a low rate during follow-up at 12 and 18 months, the researchers say.

“We are encouraged by our results, but we know that other strategies that minimize adverse health events and improve the quality of care for adolescents with diabetes and their families at this stage of life are necessary,” conclude Butalia and other investigators.

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Diabetology 2021; doi: 10.1007 / s00125-020-05368-1