Division of Endocrinology, Diabetes and Metabolism, Duke University Health System, Durham, North Carolina, USA
Division of Endocrinology, Diabetes and Metabolism, Duke University Health System, Durham, North Carolina, USA.
BMJ Open Diabetes Res Care. 2022 Nov;10(6). doi: 10.1136/bmjdrc-2022-002937.
Adolescents and young adults (AYAs) with type 1 diabetes (T1D) are at risk of suboptimal glycemic control and high acute care utilization. Little is known about the optimal age to transfer people with T1D to adult care, or time gap between completing pediatric care and beginning adult endocrinology care.
This retrospective, longitudinal study examined the transition of AYAs with T1D who received endocrinology care within Duke University Health System. We used linear multivariable or Poisson regression modeling to assess the association of (1) sociodemographic and clinical factors associated with gap in care and age at transfer among AYAs and (2) the impact of gap in care and age at transfer on subsequent glycemic control and acute care utilization.
There were 214 subjects included in the analysis (54.2% female, 72.8% white). The median time to transition and age at transition were 8.0 months and 21.5 years old, respectively. The median gap in care was extended by a factor of 3.39 (95% CI=1.25 to 9.22, p=0.02) for those who did not see a mental health provider pre-transfer. Individuals who did not see a diabetes educator in pediatrics had an increase in mean age at transition of 2.62 years (95% CI=0.93 to 4.32, p<0.01). The post-transfer emergency department visit rate was increased for every month increase in gap in care by a relative factor of 1.07 (95% CI=1.03 to 1.11, p<0.01). For every year increase in age at transition, post-transfer hospitalization rate was associated with a reduction of a relative factor of 0.62 (95% CI=0.45 to 0.85, p<0.01) and emergency department visit rate by 0.58 (95% CI=0.45 to 0.76, p<0.01).
Most AYAs with T1D have a prolonged gap in care. When designing interventions to improve health outcomes for AYAs transitioning from pediatric to adult-based care, we should aim to minimize gaps in care.
患有 1 型糖尿病（T1D）的青少年和年轻人（AYAs）存在血糖控制不佳和急性护理利用率高的风险。对于将 T1D 患者转移到成人护理的最佳年龄，或者完成儿科护理和开始成人内分泌科护理之间的时间差距，知之甚少。
本回顾性纵向研究检查了在杜克大学健康系统内接受内分泌学治疗的 AYAs 中 T1D 患者的过渡情况。我们使用线性多变量或泊松回归模型来评估（1）与 AYA 之间的护理差距和转移年龄相关的社会人口统计学和临床因素，以及（2）护理差距和转移年龄对随后血糖控制和急性护理利用的影响。
分析中包括 214 名受试者（54.2%为女性，72.8%为白人）。转移和转移年龄的中位时间分别为 8.0 个月和 21.5 岁。对于那些在转移前没有看心理健康提供者的人，护理差距的中位数延长了 3.39 倍（95%CI=1.25 至 9.22，p=0.02）。在儿科没有看糖尿病教育者的个体，转移年龄的平均值增加了 2.62 岁（95%CI=0.93 至 4.32，p<0.01）。护理差距每增加一个月，转后急诊就诊率就会增加一个相对因素 1.07（95%CI=1.03 至 1.11，p<0.01）。随着转移年龄的每增加一年，与转后住院率相关的相对因素减少了 0.62（95%CI=0.45 至 0.85，p<0.01），急诊就诊率减少了 0.58（95%CI=0.45 至 0.76，p<0.01）。
大多数患有 T1D 的 AYA 都存在护理差距延长的情况。在设计干预措施以改善从儿科到成人护理的 AYA 过渡的健康结果时，我们应旨在尽量减少护理差距。
