Levy-Shraga Y, Elisha N, Ben-Ami M, Boyko V, Lerner-Geva L, Ziv T, Konvalina N, Cohen O, Pinhas-Hamiel O
Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel.
Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Acta Diabetol. 2016 Feb;53(1):27-33. doi: 10.1007/s00592-015-0734-z. Epub 2015 Mar 22.
Emerging adulthood is a challenging period for diabetes management. Our aim was to determine whether a dedicated transition clinic for emerging adults with type 1 diabetes can improve glycemic control and visit attendance.
An observational study of 53 emerging adults (30 males) treated during 2010-2014 in a newly established transition clinic. The clinic was operated jointly by pediatric and adult endocrinologists and included a transition coordinator. Data collected included the source of referral, HbA1c levels, frequency of visit attendance, and acute complications. For 27 patients who had attended the pediatric clinic at the same medical center, data from up to 2 years preceding the transition were also collected. Patients filled the Diabetes Quality of Life-Youth questionnaire at the transition and 1 year later.
Mean ± SD age at the transfer to the transition clinic was 22.1 ± 2.7 years; mean disease duration was 8.4 ± 5.0 years. Follow-up duration at the transition clinic was 1.2 ± 1.1 years. Mean HbA1c levels decreased from 67 mmol/mol (95 % CI 63-72) [8.3 % (95 % CI 7.9-8.7)] at transfer to 57 mmol/mol (95 % CI 52-63) [7.4 % (95 % CI 6.9-7.9)] after 1 year (p < 0.001). Thirty-six patients (68 %) attended three or more visits during their first year in the transition clinic. The impact of diabetes on quality of life, disease-related worries, and life satisfaction did not change significantly during 1-year attendance in the transition clinic.
A dedicated transition clinic for emerging adults, with tailored support according to the developmental needs of emerging adulthood, showed improved glycemic control and visit attendance.
成年初显期是糖尿病管理的一个具有挑战性的阶段。我们的目的是确定一个专门为患有1型糖尿病的成年初显期患者设立的过渡诊所是否能改善血糖控制和就诊率。
对2010年至2014年期间在一家新设立的过渡诊所接受治疗的53名成年初显期患者（30名男性）进行了一项观察性研究。该诊所由儿科和成人内分泌科医生联合运营，并设有一名过渡协调员。收集的数据包括转诊来源、糖化血红蛋白（HbA1c）水平、就诊频率和急性并发症。对于在同一医疗中心儿科诊所就诊过的27名患者，还收集了过渡前长达2年的数据。患者在过渡时和1年后填写了糖尿病青少年生活质量问卷。
转至过渡诊所时的平均年龄±标准差为22.1±2.7岁；平均病程为8.4±5.0年。在过渡诊所的随访时间为1.2±1.1年。平均HbA1c水平从转来时的67 mmol/mol（95%可信区间63 - 72）[8.3%（95%可信区间7.9 - 8.7）]降至1年后的57 mmol/mol（95%可信区间52 - 63）[7.4%（95%可信区间6.9 - 7.9）]（p < 0.001）。36名患者（68%）在过渡诊所的第一年就诊三次或更多次。在过渡诊所就诊1年期间，糖尿病对生活质量、疾病相关担忧和生活满意度的影响没有显著变化。
一个专门为成年初显期患者设立的过渡诊所，根据成年初显期的发展需求提供量身定制的支持，显示出改善了血糖控制和就诊率。
