Structured Care Program Offers Youth with Type 1 Diabetes Improved Transition from Pediatric to Adult Care
SAN DIEGO, June 12, 2017 /PRNewswire-USNewswire/ -- Adolescents and young adults with type 1 diabetes benefit from a structured transition program when changing from pediatric to adult diabetes care, resulting in improvements in clinic attendance and satisfaction, as well as decreased emotional burden for the duration of intervention, according to the study, "A Structured Transition Program in Young Adults with Type 1 Diabetes Is Associated with Improved Satisfaction with Diabetes Care," presented today at the American Diabetes Association's 77th Scientific Sessions® at the San Diego Convention Center.
Successful management of diabetes requires a high level of patient involvement, and lifelong health care is essential. The transition from pediatric care to adult care can be particularly difficult for people with diabetes. Young adult patients with diabetes who move from receiving care in a pediatric setting to an adult setting can struggle with managing their diabetes and are susceptible to worsening glycemic control and its complications.
This multi-center, randomized trial in Canada enrolled 205 youth between the ages of 17 and 20 with type 1 diabetes who received care at diabetes clinics in academic or community settings. The study aimed to determine if a structured transition intervention program, and in particular access to a Transition Coordinator, would prove beneficial to young adults with type 1 diabetes during the transition of care from adolescence to adulthood. The patients were randomly assigned to two groups—one with 104 patients in a structured transition care program, and one with 101 patients who received standard care, which did not include access to a Transition Coordinator. The transition program was designed to provide additional support to the youth and included a dedicated Transition Coordinator, who was a certified diabetes educator, to assist the patients in the transition process. The coordinator attended the patients' clinic visits, and was accessible between visits by email, text or phone to problem solve specific diabetes care issues, and to coach the patients in navigating the health care system.
During the 18-month program, patients were seen in the pediatric care setting for six months, and then transferred to adult care, where they continued intervention or standard care for one year. Patients were given questionnaires to complete, including the Client Satisfaction Questionnaire (CSQ), the Diabetes Quality of Life (DQL) questionnaire, and the Diabetes Distress Scale (DDS) questionnaire upon enrollment in the program, and again upon completion of the program. Questionnaires were completed by 71 (68.3 percent) of the patients in the structured transition program and by 57 (56.4 percent) of the patients in the standard care group. Patients in the structured transition group had contact with transition coordinators an average of 17.6 times per patient (as per study design, the standard care group had no access to a Transition Coordinator) during the 18 months. They also attended more clinic visits (on average 4.1 total visits per patient), compared to the patients in the standard care group (on average 3.6 total visits per patient). Patients in the transition group reported they were more satisfied with care than patients in the standard care group (28.9 percent vs. 27.9 percent, p=0.04), and they reported less emotional burden of diabetes (2.3 percent vs. 2.7 percent, p=0.03).
"Transition of care is a high-risk period associated with significant health care gaps, missed intervention opportunities and worse health outcomes," said lead study author Tamara Spaic, MD, MSc, assistant professor in the department of medicine, division of endocrinology and metabolism at the University of Western Ontario. "This is the first study to address the transition problem in a rigorous, scientific manner, and we were pleased to find improved clinic attendance rates and satisfaction with care during the intervention period. Although A1C levels were not statistically different between the two groups of patients, we were encouraged to see a trend for improved blood sugar control in the group with access to the Transition Coordinator, while the opposite was seen in the group who did not have this opportunity. Transition coordinator support should become a standard of care for young adults with type 1 diabetes during the transition from pediatric to adult diabetes case since it improves continuity and satisfaction of care. A similar model could also be considered in other chronic childhood conditions, such as cystic fibrosis, congenital heart disease and inflammatory bowel disease."
Outcomes of the study will be further evaluated during a one-year follow-up after completion of the intervention, and an economic analysis will be conducted to determine if this transition intervention is associated with health cost savings.
To speak with Dr. Spaic, please contact the Association's media relations team on-site at the San Diego Convention Center on June 9 - 13, by phone at 619-525-6250 or by email at [email protected].
The American Diabetes Association's 77th Scientific Sessions, to be held June 9-13, 2017, at the San Diego Convention Center, is the world's largest scientific meeting focused on diabetes research, prevention and care. During the five-day meeting, health care professionals have exclusive access to more than 2,500 original research presentations, participate in provocative and engaging exchanges with leading diabetes experts, and can earn Continuing Medical Education (CME) or Continuing Education (CE) credits for educational sessions. The program is grouped into eight interest areas: Acute and Chronic Complications; Behavioral Medicine, Clinical Nutrition, Education and Exercise; Clinical Diabetes/Therapeutics; Epidemiology/Genetics; Immunology/Transplantation; Insulin Action/Molecular Metabolism; Integrated Physiology/Obesity; and Islet Biology/Insulin Secretion. Brenda Montgomery, RN, MSHS, CDE, President of Health Care and Education[1], will deliver her address on Saturday, June 10, and Alvin C. Powers, MD, President of Medicine and Science, will present his address on Sunday, June 11. Eight abstracts were selected by the Scientific Sessions Meeting Planning Committee to be presented on Tuesday, June 13, in the President's Oral Session. These abstracts represent important research being conducted in the field of diabetes today. In total, the 2017 Scientific Sessions includes 378 abstracts in 49 oral sessions; 2,152 poster presentations including 50 moderated poster discussions; and 360 published-only abstracts. Join the Scientific Sessions conversation on Twitter, #2017ADA.
About the American Diabetes Association
More than 29 million Americans have diabetes, and every 23 seconds another person is diagnosed with diabetes. The American Diabetes Association (Association) is the global authority on diabetes and since 1940 has been committed to its mission to prevent and cure diabetes and to improve the lives of all people affected by diabetes. To tackle this global public health crisis, the Association drives discovery in research to treat, manage and prevent all types of diabetes, as well as to search for cures; raises voice to the urgency of the diabetes epidemic; and provides support and advocacy for people living with diabetes, those at risk of developing diabetes and the health care professionals who serve them. For more information, please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or visit diabetes.org. Information from both of these sources is available in English and Spanish. Find us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn).
292-OR A Structured Transition Program in Young Adults with Type 1 Diabetes Is Associated with Improved Satisfaction with Diabetes Care
77th Scientific Sessions
News Briefing: Youth with Diabetes, Saturday, June 10, 4:00 p.m. PT
Oral Presentation: From Prediction to Transition—Type 1 Diabetes Mellitus across Stages
Location: 30
Session Time: Monday, June 12, 2017, 8:00 -10:00 a.m.
Authors: TAMARA SPAIC, ELLEN GOLDBLOOM, PATRICIA GALLEGO, IRENE HRAMIAK, MARGARET LAWSON, JANINE MALCOLM, JEFFREY MAHON, DERIC MORRISON, AMISH PARIKH, ANGELO SIMONE, ROBERT STEIN, CHERIL CLARSON, London, ON, Canada, Ottawa, ON, Canada, Mississauga, ON, Canada
Transition from pediatric to adult diabetes care in young adults (YA) with type 1 diabetes (T1D) is associated with poor health outcomes. We initiated a multicenter randomized trial to determine if a structured transition program in YA (age 17-20 yrs) with T1D improves clinic attendance, complication screening, and glycemic control, after transition from pediatric to adult care. The structured program was designed to provide support to the intervention arm participants during the transition period with diabetes educators functioning as the Transition Coordinators (TC) via text, email, phone and/or clinic visits. During the 18-month intervention, subjects were seen in the pediatric care setting for 6 months and then transferred to adult care where they continued intervention for 1 year. Client Satisfaction Questionnaire (CSQ), Diabetes Quality of Life (DQL), and Diabetes Distress Scale (DSS) were administered at enrollment and completion of the intervention.
Two hundred and five subjects were randomized (104 structured transition; 101 standard care). Seventy one (68.3%) subjects in structured transition and 57 (56.4%) in standard care completed the questionnaires. There were a mean of 17.6±7.3 contacts per subject with TC during the 18-month intervention. Structured transition subjects attended more clinic visits than those in standard care (4.1±1.1 vs. 3.6±1.2, p=0.002). YA in structured transition were more satisfied with care than those in standard care (28.9±2.7 vs. 27.9±3.4, p=0.04) and reported less emotional burden of diabetes (2.3±1.1 vs. 2.7±1.2%, p=0.03). The DQL and DSS found no differences between the groups for physicians, insulin regimen, or interpersonal domains.
A structured transition program in YA with T1D was associated with greater clinic attendance, improved satisfaction and less emotional burden with diabetes care. Outcomes will be further assessed during the one year follow-up after completion of the intervention.
Author Disclosures:
T. Spaic: Consultant; Author; Sanofi Canada, Eli Lilly Canada Inc. Research Support; Author; AstraZeneca, Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Novo Nordisk Inc., Juvenile Diabetes Research Foundation. Speaker's Bureau; Author; Sanofi Canada, Novo Nordisk Inc. E. Goldbloom: None. P. Gallego: None. I. Hramiak: Research Support; Author; Eli Lilly Canada Inc., AstraZeneca, Bristol-Myers Squibb Company, GlaxoSmithKline, Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Merck Canada Inc.. M. Lawson: None. J. Malcolm: None. J. Mahon: None. D. Morrison: None. A. Parikh: None. A. Simone: None. R. Stein: None. C. Clarson: Advisory Panel; Author; Pfizer Inc. Research Support; Author; Juvenile Diabetes Research Foundation, Canadian Institutes of Health Research. Speaker's Bureau; Author; Eli Lilly Canada Inc., Medtronic MiniMed, Inc.
[1] Disclosures for Brenda Montgomery. Employer: AstraZeneca Pharmaceuticals. Montgomery's role as President, Health Care & Education of the American Diabetes Association (Association) is a voluntary position to which she was elected by the members of the Association in 2015. She continues to recuse herself from any and all discussions, decisions or votes that have or could be perceived as having a conflict of interest with her employer.
SOURCE American Diabetes Association
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