HealthDay News — For patients diagnosed with type 1 diabetes during adolescence, the transition from pediatric to adult diabetes care is associated with increased risk for poor glycemic control, study results show.
At follow-up during young adulthood, patients who transitioned to an adult provider during adolescence were about 2.5 times more likely to have a hemoglobin A1c of 9% or higher compared with those who had continued receiving care from a pediatric provider (odds ratio=2.46; 95% CI: 1.09-5.55), according to Debra S. Lotstein, MD, MPH, of the David Geffen School of Medicine at the University of California Los Angeles.
“These findings suggest that to safely follow current guidelines, young adults who transition to adult care require additional support to maximize their health outcomes that will extend for some time beyond the transfer to an adult provider,” Lotstein and colleagues reported in Pediatrics.
Many practice guidelines currently recommend that teens make the transition to adult care from ages 18 to 21 years, according to background information in the article.
In order to better understand the sociodemographic and clinical correlates of poor glycemic control associated with transfer of care from pediatric to adult diabetes providers, the researchers examined data from 185 adolescents who were recently diagnosed with type 1 diabetes who participated in the SEARCH for Diabetes in Youth Study.
The SEARCH study enrolled patients who received a type 1 diabetes diagnosis from ages 13 to 19 years. All patients received care from a pediatric endocrinologist or pediatrician at baseline and were followed up when they were 18 or older. Average patient age was 15 years at diagnosis, 16 years at study baseline, and 20.5 years at follow-up.
By the follow-up visit, 57% of participants had moved to adult care providers at an estimated median age of 20.1 years. About 75% of patients made the transition in accordance with guidelines before the age of 21 years, the researchers found.
At baseline, 11% of patients had poor glycemic control (defined as a hemoglobin A1c of 9% or higher), and at follow-up this proportion increased to 45%.
Increased odds of transition to adult care were independently associated with older age, lower baseline glycosylated hemoglobin and less parental education. Nonwhite ethnicity was also associated with a greater likelihood of poor glycemic control at follow-up (OR=3.44; 95% CI: 1.17-10.1).
Although the study did not assess reasons for the decline in maintaining adequate glycemic control, the researchers hypothesized that less psychosocial support and less access to diabetes education services in adult healthcare settings may play a role.