Garvey Katharine C, Foster Nicole C, Agarwal Shivani, DiMeglio Linda A, Anderson Barbara J, Corathers Sarah D, Desimone Marisa E, Libman Ingrid M, Lyons Sarah K, Peters Anne L, Raymond Jennifer K, Laffel Lori M
Boston Children's Hospital, Boston, MA.
Jaeb Center for Health Research, Tampa, FL
Diabetes Care. 2017 Mar;40(3):317-324. doi: 10.2337/dc16-1729. Epub 2016 Dec 22.
Young adults with type 1 diabetes transitioning from pediatric to adult care are at risk for adverse outcomes. We developed a survey to evaluate transition experiences in two groups of young adults with type 1 diabetes, before (PEDS) and after (ADULT) transition to adult care.
We fielded an electronic survey to young adults (18 to <30 years) at 60 T1D Exchange Clinic Registry centers.
Surveys were completed by 602 young adults, 303 in the PEDS group (60% female, age 20 ± 2 years) and 299 in the ADULT group (62% female, age 24 ± 3 years). In the PEDS group, mean anticipated transition age was 22 ± 2 years; 64% remained in pediatric care because of emotional attachment to the provider. The ADULT group transitioned at age 19 ± 2 years, mainly after pediatric provider recommendation. More than 80% of respondents reported receiving counseling on type 1 diabetes self-management and screening tests from pediatric providers, but less than half (43% PEDS and 33% ADULT) reported discussing reproductive health. In the PEDS group, half had discussed transfer with pediatric providers. Of the ADULT participants, 63% received an adult provider referral, and 66% felt mostly/completely prepared to transition. ADULT participants with fewer pretransition pediatric visits or who felt unprepared for transition had increased odds of gaps >6 months between pediatric and adult care. Receipt of transition preparation counseling was not associated with self-reported hemoglobin A <7.0% in either group.
These results support the need for intensive efforts to integrate transition preparation counseling and care coordination into pediatric type 1 diabetes care.
1型糖尿病青年患者从儿科护理过渡到成人护理时面临不良后果的风险。我们开展了一项调查，以评估两组1型糖尿病青年患者在过渡到成人护理之前（儿科组）和之后（成人组）的过渡经历。
我们在60个1型糖尿病交流诊所登记中心对青年患者（18至<30岁）进行了电子调查。
602名青年患者完成了调查，儿科组303人（60%为女性，年龄20±2岁），成人组299人（62%为女性，年龄24±3岁）。在儿科组中，平均预期过渡年龄为22±2岁；64%的患者因对医护人员有情感依赖而仍接受儿科护理。成人组在19±2岁时过渡，主要是在儿科医护人员推荐之后。超过80%的受访者报告从儿科医护人员那里接受了1型糖尿病自我管理和筛查测试方面的咨询，但报告讨论生殖健康的不到一半（儿科组43%，成人组33%）。在儿科组中，一半患者与儿科医护人员讨论过转诊事宜。在成人组参与者中，63%收到了成人医护人员的转诊，66%的人感觉大部分/完全为过渡做好了准备。过渡前儿科就诊次数较少或感觉对过渡没有准备的成人参与者，儿科护理和成人护理之间间隔超过6个月的几率增加。在两组中，接受过渡准备咨询与自我报告的糖化血红蛋白<7.0%均无关联。
这些结果支持需要大力努力将过渡准备咨询和护理协调纳入儿科1型糖尿病护理中。
