Tremblay Elise Schlissel, Ruiz Jessica, Buccigrosso Tess, Dean Taylor, Garvey Katharine
Department of Pediatrics, Division of Endocrinology, Boston Children's Hospital, Boston, MA.
Boston Combined Residency Program, Boston Children's Hospital, Boston, MA.
Diabetes Spectr. 2020 Nov;33(4):331-338. doi: 10.2337/ds20-0011.
| To explore expectations for transition to adult care and experiences with transition planning among adolescents and young adults with type 1 diabetes and an A1C >9% at a tertiary care U.S. pediatric center. | We conducted semi-structured interviews in a purposive sample of patients 14-23 years of age who had had type 1 diabetes for at least 1 year and had an A1C >9%. A multidisciplinary team conducted iterative thematic analysis with deductive and inductive coding aided by NVivo software. | Fourteen subjects participated (nine adolescents and five young adults, mean age 17.1 ± 3.2 years, 57% male, 79% Caucasian, 14% Hispanic, diabetes duration 8.2 ± 4.6 years, mean A1C 10.0 ± 0.8% for adolescents and 10.1 ± 0.7% for young adults). Qualitative analysis yielded four key themes. The first was lack of formal preparation; participants of all ages demonstrated a lack of preparation for transition and ignorance about the process, describing it as coming "out of the blue." The second was a desire for delayed and gradual transition; participants wanted to defer being "serious" about transition to a later/uncertain date, with a preference to "wait until I'm older" among all ages. Participants described ideal transition as a gradual process, taking place "a little at a time." The third was attachment to pediatric providers; participants demonstrated a nearly universal attachment to and "familiarity" with their pediatric diabetes care providers and expressed worries about an "uncomfortable" transition to adult providers. The fourth was concern about an impersonal adult care setting: participants perceived adult care as "formal," "scarier," and "tougher," with increased criticism about poor control; participants expressed fear that adult providers would not "know me" or appreciate "my diabetes journey." | We demonstrated a lack of transition preparation and anxiety about transition and adult care among youth with type 1 diabetes and elevated A1C. Our results may help guide early, iterative pediatric transition counseling, with a special focus on addressing attachment and fears about adult diabetes care.
在美国一家三级医疗儿科中心，探讨1型糖尿病且糖化血红蛋白（A1C）>9%的青少年和青年向成人护理过渡的期望以及过渡计划的经历。
我们对14至23岁、患1型糖尿病至少1年且A1C>9%的患者进行了目的抽样的半结构化访谈。一个多学科团队借助NVivo软件，通过演绎和归纳编码进行迭代主题分析。
14名受试者参与了研究（9名青少年和5名青年，平均年龄17.1±3.2岁，57%为男性，79%为白种人，14%为西班牙裔，糖尿病病程8.2±4.6年，青少年平均A1C为10.0±0.8%，青年为10.1±0.7%）。定性分析得出四个关键主题。第一个是缺乏正式准备；各年龄段的参与者都表现出对过渡缺乏准备且对该过程一无所知，形容其“突如其来”。第二个是希望延迟和逐步过渡；参与者希望将对过渡的“认真对待”推迟到更晚/不确定的日期，各年龄段都倾向于“等到我长大一些”。参与者将理想的过渡描述为一个渐进的过程，“一次一点地”发生。第三个是对儿科医护人员的依恋；参与者几乎普遍对其儿科糖尿病护理人员有依恋和“熟悉感”，并表达了对向成人医护人员“不自在”过渡的担忧。第四个是对成人护理环境缺乏人情味的担忧：参与者认为成人护理“形式化”、“更可怕”和“更严格”，对控制不佳的批评增多；参与者表示担心成人医护人员不“了解我”或不理解“我的糖尿病历程”。
我们证明了1型糖尿病且A1C升高的青少年缺乏过渡准备以及对过渡和成人护理的焦虑。我们的结果可能有助于指导早期、迭代的儿科过渡咨询，特别关注解决对成人糖尿病护理的依恋和恐惧。
